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SPECIAL PATHOLOGY 

AND 

DIAGNOSTICS 

WITH 

THERAPEUTIC HINTS 



C. G. RAUE, M.D. 



SECOND EDITION 

REWRITTEN AND ENLARGED. 





BOERICKE & TAFEL: 



NEW YORK: PHILADELPHIA: 

145 GRAND STREET. 1011 ARCH STREET. 

London: Trubner & Co., Lddqate Hill. 
London: Homoeopathic Publishing Co., No. 2 Finsbury Circus. 

1882. 



X 







Copyright, C. G. fiaue, 1SS1. 




MY STUDENTS, 

NEAR AND FAR, 
IN WHOSE BEHALF THE FIRST EDITION WAS ELABORATED, 

AND 
TO THE MEMORY OF OUR MUTUAL FRIEND AND TEACHER, 

CONSTANTINE HERING, 

THIS SECOND EDITION IS DEDICATED. 



PREFACE TO SECOND EDITION. 



^HE first edition had become old; it needed renovation. 
The pathological views had changed so grievously since 
its appearance, that a re-statement of the same through- 
out the work became a necessity. 

Not so, however, the therapeutic hints. They are as 
true to-day as they were when written years ago, and, I 
am happy to say, have been reliable guides at the bed- 
side to many physicians, and also a fruitful source, ac- 
knowledged or not, to many writers in journals and of 
books. What I had to do with these hints was this: to 
express their meaning still more accurately, to enlarge 
their 'spheres, and to add such new facts as the experi- 
ence of others and my own would admit. This has aug- 
mented to a considerable extent even the therapeutic 
part of the work, and thus I may state in truth, that this 
second edition is re-written for the most part, that it is 
greatly enlarged and, I hope, also greatly improved. 

Although I have given credit in the text to the several 
authors from whom I have drawn, it may be well to 
mention the principal sources for the pathological part: 
von Ziemssen's Cyclopaedia, French's Diseases of the 
Liver, Walton's work on the Eye and von Trcelsch's work 
on the Ear. Compare also the introductory remarks to 
the first edition. The therapeutic hints I have selected 
from the entire homoeopathic literature, using all such 
indications as I deemed reliable and characteristic. 

(5) 



The chapter on the eye has been kindly and carefully 
overhauled in the manuscript by Dr. G. S. Norton, and 
that on the ear by Drs. G. S. Norton and Henry C. 
Houghton; their valuable notes will be found credited 
to them in the text. 

The arrangement is the same as that of the first edition. 

Although great pains have been taken to avoid clerical 
errors, nevertheless some have crept in, for instance, saly- 
cilic for salicylic and others. Wherever you find them, 
please correct them. 

C. G. Ratje. 

Philadelphia, 121 North Tenth St., 

in the month of September, 

1881. 



INTRODUCTORY REMARKS TO FIRST EDITION. 



"Y^HEN I was called upon to lecture on Special Pathol- 
ogy and Diagnostics, about four years ago, I looked 
around for a work which would furnish the essential 
points of these branches of medical education, together 
with Homoeopathic Therapeutics, in a concise manner 
and up to the latest researches ; but I looked in vain. I 
was obliged to prepare my own materials. The result of 
these labors seemed, in the estimation of my pupils and 
indulgent friends, worthy of a more permanent form and 
a wider diffusion than oral teaching affords. 

In its preparation I have consulted the best recent as 
well as older works on the different subjects contained 
herein: Virchow, Rokitansky, Vogel, Griesinger, Hasse, 
Wintrich, Bamberger, Simon, Niemeyer, Bock, Bednar, 
Hiibner, Kiittner, Wagner, Skoda, Hebra, Wilson, Da 
Costa, Hughes, Barclay, Bryan, Hammond; Hahnemann, 
Hering, v. Boenninghausen, Riickert, Oehme, Hartmann, 
Jahr, v. Grauvogl, Miiller, Meyer, Baehr, Kafka, Ludlam, 
Hale, Wells, Dunham, and others; New York Homoeo- 
pathic Transactions and various journals. I have made 
free use of all of them as far as they suited my purpose, 
but have not followed any one exclusively. The ar- 
rangement, selection and elaboration of the whole are 
my own. The composition, however, would have un- 
avoidably contained many Germanisms had they not 
been expurgated. I am indebted to Dr. G. R. Starkey, 
formerly Professor of Surgery in the Homoeopathic Col- 
lege of Pennsylvania, for his kind offices in correcting 

(7) 



INTRODUCTORY REMARKS. 



the manuscript so as to render it more agreeable to the 
English ear. 

This book does not pretend to be a special Therapia, 
because, as v. Grauvogl already remarks : "It is impossible 
to prepare a complete, special Therapia for any so-called dis- 
ease ; just as impossible as to describe all human beings of all 
times, because the conditions of getting sick change constantly 
in the course of timer What the genius epidemicus re- 
quires, for example, in an epidemic of whooping-cough 
at this season may not answer at all for a like epidemic 
of next year. Hence, my intention has been to give only 
therapeutic hints. These hints I have carefully selected 
out of the rich treasury of our Homoeopathic literature, 
and I have added the results of my own experience. But 
all this does not make it perfect. Many a colleague, on 
opening the book and glancing over this or that chapter, 
will miss one or another remedy which he has been ap- 
plying successfully in a certain form of disease. It lies 
in the nature of such a work that this must be so. On 
being informed, however, of such remedies and their 
characteristic indications, the author would be happy to 
receive and apply them. 

This book does not give any prescriptions in regard to 
the dose, because that is still an open question, and must 
be left entirely to the free judgment of the practitioner. 
My hints are collected from all sorts of observations, with 
low, middle, high and highest potencies. I, myself, pre- 
fer the higher potencies; and it is possible that the more 
accurately we individualize the more we may become in- 
clined to choose the highest. Others may think differ- 
ently. So much is certain, that there are undoubted 
facts which seem to favor both sides of the question. 
Cases are recorded in which low potencies were given in 
vain, and a higher one of the same remedy at once 
effected a cure, and vice versa. Judge then for thyself. 

THE AUTHOR. 



CONTENTS. 



HEAD. 

Diseases of the Brain and its Membranes. 

Anaemia, 33 

Hyperemia, .36 

Vertigo, 41 

Sleep, Stupor, Insomnia, 52 

Meningitis tuberculosa, Hydrocephalus acutus, . . . 58 
Leptomeningitis infantum, Hydrocephalus acutus sine tuberculosis; 

simple Meningitis, 60 

Simple meningitis of the base, 61 

Meningitis of the convexity, ......... 62 

Metastic meningitis, 62 

Traumatic meningitis, 63 

Hydrocephalus chronicus, 68 

Hydrocephalus congenitus, . 68 

Hydrocephalus senilis, 70 

Meningitis cerebro-spinalis epidemica, spotted fever, .... 70 

Pachymeningitis, inflammation of the dnra mater, .... 75 

Encephalitis, abscess of the brain, red and white softening of the brain, 76 

Insulatio, sunstroke, thermic fever, 78 

Apoplexia sanguinea, . 81 

Occlusion of the cerebral arteries, ^nbolism and thrombosis, softening 

of the brain, m .- . 87 

Aphasia, ■ 89 

Thrombosis of the cerebral sinuses, 93 

Hypertrophy of the brain, 94 

Atrophy of the brain, . 95 

Dementia paralytica, .......... 96 

Senile dementia, 98 

Delirium tremens, .......... 103 

Chronic alcoholism, dipsomania, 106 

Opium and morphine poisoning, ........ 110 

Tumors of the brain and its membranes, Ill 

(ix) 



X CONTENTS. 

Diseases of the Cranium and its Integuments. 

a. Abnormal largeness of the head. 

Dropsy of the scalp, 114 

Hypertrophy of the skull, . . 115 

The bruised head of a child after birth, 115 

b. Abnormal smallness. 

c. Affections of the skull without enlargement. 

Atrophy of the skull, 117 

d. Diseases of the integuments. 

Erysipelas of the scalp and face, 118 

Eczema capitis, humid tetter or scald, 122 

Impetigo, 123 

Dandruff, 125 

Seborrhcea capillitii, . 126 

Favus, honey-comb ringworm, tinea favosa or maligna, porrigo favosa 

or lupinosa, 126 

Tinea, herpes tonsurans, or ringworm of the scalp, . . . . 128 

The wen, 128 

Teleangiectasia, or vascular naevus, mother's mark .... 128 

The hair. 

Alopecia, 129 

Baldness, 129 

Change in color, 130 

Plica palonica, matted hair, 130 

EYES. 

General observations, 131 

Lids and Lachrymal Apparatus. 

Inflammation of the eyelids, 131 

Hordeolum, 136 

Tumors of lids, 137 

Dacryocystitis, 138 

Blennorrhea of lachrymal sac, 139 

Conjunctiva. 

Catarrhal ophthalmia, 140 

Purulent ophthalmia, 142 

Gonorrhoeal ophthalmia, 143 

Ophthalmia neonatorum, 143 

Granular ophthalmia 145 

Phlyctenular ophthalmia, 147 

Diphtheritic conjunctivitis, 150 

Croupous conjunctivitis, 150 

Pterygium, 151 



CONTENTS. XI 

Cornea. 

Corneitis, Keratitis, 152 

Abscess of cornea 153 

Onyx, . 153 

Hypopion, 153 

Staphyloma 154 

Sclerotica. 

Scleritis, Sclerotitis 157 

Iris. 

Iritis, 158 

Choroidea. 

Choroiditis, 161 

Glaucoma, 163 

Optic Nerve and Retina. 

Neuro-retinitis, 166 

Hemiopia, ............ 168 

Hemeralopia, night-blindness, 169 

Hyperesthesia retinae, 169 

Lens. 

Cataract, 170 

Sight. 

Kefraction and accommodation, 172 

Presbyopia or old sight, 174 

Hypermetropia, 175 

Myopia or short-sightedness, ......... 175 

Astigmatism, 176 

Asthenopia, 177 

Muscles and Nerves. 

Mydriasis, 179 

Myosis, 179 

Ptosis, falling of upper lid, 180 

Strabismus, squint, 180 

Nystagmus, trembling of eyeballs, 181 

Luscitas, or fixed state of eyeball, . . . . . . . . 182 

Morbid winking, 182 

Twitching of lids or quivering, ........ 182 

Blepharospasm, 182 

Neuralgia of eye, 183 



Orbit. 



Orbital cellulitis, 184 

Basedow's or Grave's disease; exophthalmic goitre, .... 184 



Xll CONTENTS. 

EAES. 

Analogy between ear and eye, 

General observations on ear 

Auricle. 

Eczema, 

Auditory canal and drumhead or membrana tympani. 

Examination of these parts, 

Earwax diminished or increased 

Furuncles of external canal, 

Otitis externa, or diffuse inflammation of the auditory canal, 



188 
189 



191 

193 
195 
190 



The Middle Ear. 

Examination of the middle ear, 

Otitis media, 

Chronic forms of otitis media, 

Polypi, 

Nervous deafness 

Meniere's disease, 

Tinnitus aurium, 

Otalgia nervosa, 

NOSE. 

General observations, 

Examination of the cavity of the nose, . 
Catarrh, coryza, cold in head, 

Chronic catarrh, ozsena, 

Influenza, grippe 

Yearly cold, rose cold, hay fever, hay asthma, 

Epistaxis, nosebleed, 

Polypi in nose, 

Inflammation of the nose, . 



197 
202 
207 
212 
213 
214 
215 
216 



217 
219 
220 
225 
229 
231 
232 
234 
234 



General observations, 
Erysipelas of face, . 
Crusta lacten, milk crust, 
Comedo, acne punctata et rosacea, 

Lupus, 

Ulcus rodens and epithelioma, 



235 
239 
239 

241 
242 
242 



MOUTH. 



Its external parts, 



CONTENTS. 



The Gums. 



Parulis, gumboil, inflammatory swelling of the gums 245 

Epulis, a kind of fungoid growth on the gums, 245 

Fistula of the teeth, 246 

The Teeth. 

Odontalgia, toothache, 248 

Swelled face from toothache, 265 

The Tongue. 

Its color, 266 

Its humectation, 266 

Its temperature, 267 

Its covering and coating, 267 

Its form and size, • 268 

Cracks and fissures, 269 

Paralysis, 269 

Glossitis, inflammation of tongue, 270 

Cancer of tongue, 272 

The Salivary Glands and their Ducts. 

Saliva, 273 

Parotitis, 274 

Eanula, frog, 277 

The Tonsils. 

Inflammation of tonsils, amygdalitis, tonsillitis, angina tonsillaris, . 278 

The Uvula, Soft Palate and Fauces. 

Angina faucium, angina catarrhalis, sore throat, ..... 281 

Chronic sore throat, angina granulosa or follicularis, .... 283 

Ulcers in the fauces, ulcerated sore throat, ...... 286 

Retro-pharyngeal abscess, 287 

Deep inflammation of the connective tissue of the throat ; angina Lidi - 

vici, 288 

The Mucous Membrane of the Mouth in General. 

Parasitic sore mouth of infants, thrush, 289 

Stomatitis ulcerosa, ulcers in the mouth, 291 

Diphtheria, diphtheritis, 294 

Noma, gangrene of the cheeks, 306 



NECK. 

General observations, 307 

Bronchocele, stroma or goitre, 308 



Oesophagitis, dysphagia inflammatoria 309 

Stenosis oesophagi, narrowing of the oesophagus, 311 

Dilatation of the oesophagus, . . 312 

Larynx and Trachea. 

Auscultation, 314 

Laryngoscopy, 31o 

Acute catarrhal laryngitis, catarrh of larynx, 317 

Laryngitis catarrhalis chronica, 320 

Croup, 322 

CEdenia glottidis, oedema laryngis, 327 

Perichondritis laryngea, 329 

Phthisis laryngis, tubercular ulceration, 330 

Syphilis laryngis, 332 

Neoplasms of larynx, 332 

Neuroses of the larynx, . . ... . . ■ • • • 333 

Hyperaesthesia and neuralgia, 334 

Paralysis, 334 

Spasm of the glottis, 336 



THORAX. 

Inspection, ..." 339 

Palpation, 342 

Percussion, 346 

Auscultation, 351 

Affections of the Bronchial Tubes. 

Bronchitis, bronchial catarrh, 365 

Tussis convulsiva, pertussis, whooping cough, 376 

Bronchial asthma, asthma bronchiale nervosum seu convnlsinum, . 380 

Affections of the Pulmonary Parenchyma. 

Pneumonia, 385 

Pulmonary consumption, phthisis, 394 

Acute miliary tuberculosis, 403 

Emphysema pnlmonum, 405 

Hyperemia and oedema of the lungs, 409 

Gangraena pulmonum 411 

Haemorrhage of lungs, haemoptoe, haemoptysis, ..... 412 



Pleura. 



Pleuritis, pleurisy, inflammation of the pleura, 415 

Pneumothorax, 424 

Hydrothorax, dropsy of the chest, 426 

Haematothorax, 429 



CONTENTS. XV 

THE HEART. 

Auscultation, 43() 

Diseases of the Pericardium. 

Pericarditis, inflammation of the pericardium, 438 

Hydropericardium, dropsy of the pericardium, 443 

Diseases of the Endocardium. 

Endocarditis, 444 

Insufficiency of the mitral valves, 447 

Constriction or stenosis of left auriculo- ventricular opening, . . 448 

Insufficiency of the aortic valves, 449 

Constriction or stenosis of the aortic opening, 450 

Insufficiency of the tricuspid valves, 450 

Stenosis of the right auriculo-ventricular opening, .... 451 

Insufficiency of the pulmonary valves 451 

Stenosis of the pulmonary opening, 451 

Heart clots, 453 

Diseases of the Heart- Muscle. 

Myocarditis, carditis, inflammation of the heart-muscle, . . . 454 

Hypertrophy and dilatation of the heart, 454 

Fatty heart and fatty degeneration of the heart, 456 

Nervous Affections of the Heart. 

Nervous palpitation of the heart, 458 

Angina pectoris, stenocardia, 461 

of the Aorta. 

Aneurism of the thoracic aorta, 464 



Diaphragm. 



Diaphragmitis or inflammation of the diaphragm, .... 466 

Singultus, hiccough, 467 

Neuralgia, 468 

Rupture and Perforation, 468 



ABDOMEN. 
General observations, .... 



Stomach. 



Dyspepsia, indigestion, 472 

Vomiting, 474 

Acute catarrh, gastritis, 475 

Chronic catarrh, 479 

Gastritis toxica seu caustica, 481 



XVI CONTENTS. 

Gastralgia, eardialgia nervosa, cramp of stomach, .... 482 
Ulcus ventriculi perforans or rotundum, chronicum, the round perforat- 
ing ulcer of the stomach, 486 

Carcinoma or scirrhus ventriculi, cancer of stomach, .... 490 

Haemorrhage from the stomach, hsematemesis, 495 

Gastromalacia, softening of the stomach, 498 

Intestinal Canal. 

Catarrhus intestinalis, enteritis catarrhalis, intestinal catarrh, . . 500 

Chronic intestinal catarrh, . . 503 

Typhlitis, perityphlitis and inflammation of the vermiform process, . 506 

Proctitis, catarrhal inflammation of the rectum, 510 

Periproctitis, 512 

Dysentery, 513 

Cholera, 519 

Cholera morbus or nostras or Europsea, 527 

Cholera infantum, 529 

Summer complaint, . . , 529 

Constipation, 535 

Hernia, internal and external strangulation, 540 

Tersion or twisting of the bowels, '. 543 

Intussusception, invagination, 544 

Ileus, miserere, . 545 

Haemorrhagia intestinalis, intestinal haemorrhage, malaena, . . . 546 

Haemorrhoids, piles, 547 

Flatulency, bloatedness, meteorism of the abdomen, .... 554 

Colica, enteralgia, 555 

Tuberculosis intestinalis, consumption of bowels, .... 563 

Cancer of the intestines, 564 

Polypus of rectum, 565 

Fissura ani, 565 

Fistula recti, 566 

Prolapsus recti, 568 

Proctalgia, 569 

Intestinal worms, entozoes, helminthes, 569 

Oxyuris vermicularis, thread, seat or pin-worm, 569 

Ascaris lumbricoides, round worm, 570 

Tape worms, 572 

Tricocephalus dipar, 576 

Anchylostomum duodenale, doehmius s. strongylus duodenalis, . . 576 

Trichina spiralis, . , 577 

Trichinosis, 579 

Peritoneum 5S4 

Peritonitis 584 

Ascites, dropsy of the peritoneum, 5SS 

Tympanites abdominalis, 592 



Liver. 



Physical examination, 592 

Pigment liver, melaneemic liver resulting from malarial fever, . . 593 

Hyperemia, congestion of the liver, 594 



CONTENTS. XV11 

Peri-hepatitis, inflammation of the capsule of the liver and of Glisson'a 

capsule, ............ 596 

Hepatitis vera circumscripta s. suppurativa, 597 

Cirrhosis, hob-nail liver, interstitial inflammation, gin-drinkers' liver, . 600 

Syphilitic inflammation of the liver, 602 

Acute yellow atrophy, 603 

Hepar adiposum, fatty liver, 605 

Colloid, lardaceous, warty liver, amyloid degeneration, . . . 606 

Carcinoma hepatis, cancer of the liver, 607 

Hydatids of the liver, Echinococcus cysts, 609 

Catarrhal inflammation of the biliary passages, 611 

Cholelithiasis, gall-stones, 612 

Thrombosis and occlusion of the portal vein; pylethrombosis ; pyle- 
phlebitis adha?siva chronica, 616 

Phlebitis suppurativa, purulent inflammation of the portal vein, . . 617 

Icterus, cholsemia, jaundice, . 618 

Diseases of the Spleen. 

Physical examination, 625 

Anatomical peculiarities of the spleen, ....... 627 

Hemorrhagic infarction, splenitis, lienitis or inflammation of the spleen, 627 

Acute tumor, or hyperemia of the spleen, 629 

Chronic tumor, or hypertrophy of the spleen, 630 

Cancer of the spleen, 631 

Echinococcus cysts, 631 

Rupture of the spleen, 631 

Diseases of the Pancreas. 

Pancreatitis, inflammation of the pancreas, 633 

Fatty disease of the pancreas, 633 

Cancer of the pancreas, 633 

Diseases of the Kidneys. 

Examination of urine, , . . . . 634 

Diabetes, mellituria, glycosuria, 642 

Diabetes insipidus, 651 

Hematuria, passing blood with the urine, 652 

Albuminuria, 656 

Uraemia, 657 

Acute parenchymatous nephritis, 658 

Chronic parenchymatous nephritis, 663 

Interstitial inflammation or induration of the connective tissue of the 

kidneys, 667 

Amyloid degeneration of the kidneys, lardaceous or waxy kidneys, . 671 

Suppurative nephritis, renal abscess, 673 

Nephrolithiasis, renal gravel or calculi, nephralgia, colica renalis, . 673 

Pyelitis, inflammation of the renal pelvis, 676 

Perinephritis, paranephritis, inflammation of the renal capsule, . . 677 

Morbus Addisonii, , 078 



XV111 CONTENTS. 

Diseases of the Bladder. 

Cystitis, inflammation of the bladder, 680 

Calculi vesicae, stones in the bladder, 686 

Hyperesthesia or irritability of the bladder ; spasm of the bladder, . 688 

Atony, paresis, paralysis of the bladder, 689 

Enuresis nocturna, 691 

OKGANS OF GENEEATION. 

Male Genitals. 

Venereal Diseases. 

Gonorrhoea, 693 

Complications and sequelae, 699 

Epididymitis; orchitis, 699 

Prostatis gonorrhoica, inflammation of the prostata, .... 699 

Gonorrhoea vesicae, 700 

Buboes, 700 

Ophthalmia gonorrhoica, 700 

Gonorrhoea of the rectum, 700 

Strictures of the urethra, 700 

Gonorrhoeal rheumatism, . 701 

General contamination of the system, 701 

Balanitis, gonorrhoea spuria or prseputialis, 702 

Chancre, 702 

Constitutional syphilis, • 705 

Condylomata, sycosis, fig-warts, 712 

Inguinal bubo, 713 

Syphilitic skin diseases or syphilides, 715 

Macular syphilide, 715 

Papular syphilide, 715 

Squamous syphilide, 716 

Lichen syphiliticus, 716 

Pustular syphilide, 717 

Tubercular syphilides, ; 7 IS 

Alopecia, 71S 

Alterations of nails, 71S 

Syphilitic affections of the mucous membranes, 719 

Syphilitic affections of the periosteum, of the bones and cartilages, . 719 

Syphilitic contractions of muscles and tendons, 720 

Gummata in the subcutaneous and submucous cellular tissue, . . 720 

Syphilitic affections of inner organs, 721 

Syphilis congenita seu hereditaria, 721 

Diseases of the Testes. 

Hydrocele, 722 

Orchitis, inflammation of the testicles, . . 724 

Sarcocele, Hydrosarcocele, 725 

Carcinoma testes, 725 

Varicocele, 725 

Spermatocele, 726 



CONTENTS. XIX 

Diseases of the Prostata. 

Prostatitis, inflammation of the prostate gland, 726 

Enlargement and tumors of the prostata, 727 

Diseases of the Vesiculm Seminales. 

Pollutiones nocturnae et diurnae; spermatorrhoea, 730 

Impotence; sterility in the male, 734 

Aspermatism, 735 

Azoospermatism, 735 

Female Genital Oegans. 

Examination of the parts, 736 

Ovaries. 

Oophoritis, Ovaritis, 737 

Hydrops ovarii, ovarian dropsy ; formation of cysts in the ovaries, . 740 

Uterus. 

Endometritis ; catarrh of the uterus ; leucorrhcea, 744 

Parenchymatous metritis, 751 

Hydrometra, Hsemometra, partial or total closure of the womb, . . 755 

Displacements of the womb, 756 

Anteversion and anteflexion, 757 

Retroversion and retroflexion, 757 

Prolapsus and procidentia, 758 

Inversion, . 759 

Morbid growths within the womb, 765 

Cancer of the womb, 767 

Hysteralgia, 771 

Metrorrhagia, haemorrhage from the womb, 771 



1. Menorrhagia, ' . . 776 

2. Amenorrhea, 778 

3. Dysmenorrhcea, menstruatio difficilis, 782 



Catarrh of the vagina, vaginitis, 786 

Pruritus vulvae, 787 



Mastitis, inflammation of the breast, 788 

Scirrhus seu carcinoma mammae, scirrhus or cancer of the breast, . 790 



SPINE. 

Anaemia, 793 

Hyperaemia, 794 



XX CONTENTS. 

Apoplexy, or extravasation of blood, 794 

Spinal irritation, 796 

Neurasthenia spinalis, spinal nervous weakness, 799 

Hydrorrhachis congenita, spina bifida, 800 

Leptomeningitis spinalis, 801 

Myelitis, inflammation of the spinal marrow, 803 

Myelomalacia, non-inflammatory softening of the spinal marrow, . 806 

Multiple sclerosis, 806 

Tabes dorsalis, sclerosis of the posterior columns, gray degeneration of 
the posterior columns, progressive locomotor ataxy, leukomyelitis 

posterior chronica, 809 

*~ Spasmodic spinal paralysis, 813 

Polyomyelitis anterior acuta, acute inflammation of the gray anterior 

columns (anterior horns), 815 

Polyomyelitis anterior subacuta et chronica, subacute and chronic in- 
flammation of the gray anterior horns, chronic atrophic spinal 

paralysis, 816 

Paralysis ascendens acuta, acute ascending paralysis, .... 816 

Coccyodynia, . 817 

Motory Apparatus. 

Eheumatismus, 820 

1. Eheumatismus articulorum acutus, acute rheumatism of the joints ; 

polyarthritis rheumatica acuta, 820 

2. Eheumatismus articulorum chronicus, chronic rheumatism of the 

joints, 822 

3. Eheumatismus muscularis, muscular rheumatism ; Myopathia, my- 

algia rheumatica, 823 

4. Gout, podagra, arthritis, 831 

5. Arthritis deformans, 834 

Eachitis, rickets, 835 

Malacosteon; mollities ossium; osteomalacia, softening of the bones, . 837 

Progressive muscular atrophy, 838 

Osteitis, caries, necrosis, exostosis, 840 

Tuberculosis' of the joints, white swelling 842 

Coxarthrocace, coxalgia, hip-disease, 843 

Gonorthrocace, tumor albus genu, white swelling of the knee, . . 847 

Bursitis 849 

Podarthrocace, abscess of the ankle-joint, 849 

Malum Pottii, kyphosis, angular curvature of spine, spondylarthrocace, 850 

Bunion, S51 

Ingrowing toe-nails, 850 



NEBVES. 

Amitomieal Diseases of the Nenes. 

1. Neuritis, inflammation of the nerves, 858 

2. Atrophy of the nerves, 852 

3. Hypertrophy and neoplastic formations in the nerves. . . . 5v52 



CONTENTS. 



Functional Diseases of the Nerves. 



1. Hyperesthesia, anaesthesia, 853 

2. Neuralgia, 854 

Cephalalgia, hemicrania or migraena, nervous sick-headache, ' . 855 
Neuralgia of the trigeminus or fifth nerve, prosopalgia, neuralgia facialis, 

dolor faciei Fothergillii, tic douleureux, 862 

Cervico-occipital neuralgia, 866 

Cervico-brachial neuralgia, 867 

Intercostal neuralgia, 867 

Lumbo-abdominal neuralgia, 868 

Mastodynia, neuralgia of the mammae, 868 

Neuralgia ischiadica, sciatica, ischias postica, malum cotunnii, . . 869 

Crural neuralgia, ischias antica, 873 

Anaesthesia, 873 

Anaesthesia of the trigeminus, 874 

Spasm, convulsion, cramp, hyperkinesis, 875 

Spasmus facialis, mimic spasm of the face, ...... 877 

Mogographia, graphospasms, writer's cramp, pianist's cramp, etc., . 878 

Chorea, St. Vitus' dance, 878 

Hysteria, 883 

Trismus and tetanus, 887 

Catalepsy, 891 

Epilepsy, 892 

Eclampsia acuta, 900 

Eclampsia gravidarum et parturientium, puerperal convulsions, . . 901 

Eclampsia infantum, convulsions of children, 902 

Tremor, trembling, 905 

Paralysis agitans, shaking palsy, 906 

Paralysis, akinesis, 908 

Peripheral paralyses, 909 

Spinal paralyses, 909 

Cerebral paralyses, . . . . . . . . . . . 910 

Myopathic paralyses, 910 

Infantile wasting palsy, essential infantile palsy, ..... 915 

Hydrophobia, lyssa, rabies, 916 



THE BLOOD. 



Dissolution of the red blood-corpuscles, 924 

Leukaemia, 925 

Hydraemia, 926 

Plethora, 927 

Anaemia, oligaemia, 927 

Progressive pernicious anaemia, ........ 928 

Chlorosis, 930 

Scurvy, scorbutus, 935 

Purpura hemorrhagica, morbus maculosus "Werlhofii .... 938 

Haemophilia, haemorrhophilia, 939 

Scrofulosis, 940 



FEVEE. 

Clinical thermometry, 943 

Crisis and critical days, 945 

Intermittent fever, fever and ague, 947 

Pernicious intermittent ; remittent and continuous malarial fevers; con- 
gestive fevers, 959 

Yellow fever 961 

Dengue or break-bone fever, 971 

Typhus, 972 

Typhus exanthematicus, petechial typhus, 972 

Typhoid fever, typhus abdorninalis, ileo-typhus, 975 

Abortive typhoid fever, 981 

Typhus ambulatorius, 981 

Typhus tumulturius, 981 

Pneumo-typhus, broncho-typhus, 981 

Kelapsing fever, typhus recurrens, 996 

The plague, ' 999 

Exanthemata. 

Measles, morbilli 1001 

Scarlatina, 1007 

Scarlatina maligna, typhosa, 1010 

Angina maligna, . 1010 

Eubeola, Kcetheln, • 1020 

Variola, small-pox, variolois, varioloid, 1021 

Varioloid 1025 

Purpura variolosa, 1025 

Varicella, chicken-pox, 1020 



SKIN. 

I. Hypertrophy of Shin. 

Ichthyosis or fash-skin, 1031 

II. Atrophy of the Skin. 

III. Hyperazmia and Ancemia of the Skin. 

IV. Dermatitis, Inflammation of the Skin. 

1. Erythema, 1033 

2. Herpes, 1034 

facialis, 1034 

praputialis, 1035 

Zoster, or Zona, shingles, 1035 

3. Urticaria, nettle-rash, 1036 

4. Eczema, vesicular eruption \ 1038 

5. Impetigo, pustular eruption, 1041 

contagiosa, 1041 



CONTENTS. XX111 

6. Ecthyma, isolated, large pustules, 1042 

7. Pemphigus, pompholyx, isolated large bullse, 1043 

8. Rupia or rhypia, isolated blisters which form crusts, . . . 1044 

9. Furuncles, boils, 1044 

10. Carbuncles, 1045 

11. Pustula maligna, malignant pustules, 1047 

12. Epithelioma, epithelial cancer, 1048 

13. Panaritium, paronychia, whitlow, run-around, felon, . * . . 1048 

14. Psoriasis, i 1051 

15. Lichen, 1052 

16. Prurigo, pruritus, 1053 

17. Scabies, itch, 1054 

18. Prairie itch, prurigo contagiosa, 1057 

Anomalies in the secretions of the skin. 

Sudamina, miliary rash, 1058 

Prickly heat, 1058 

Partial hyperidrosis, 1058 

Comedones, 1059 

Milium, 1059 

Atheromata, 1059 

Molluscum, 1059 



HEAD. 

DISEASES OF THE BRAIN AND ITS MEMBRANES. 



Anaemia. 

A deficiency in the proper quantity of blood in the brain in 
general, or of arterial blood in particular. Inspection shows the 
grayish substance to be paler, or nearly white; and the white 
substance still whiter than normal on account of the absence of 
the usual blood-points. The blood-vessels are not entirely empty, 
though they contain comparatively less blood than usual, while 
in most cases an increased quantity of serum has been found 
between the subarachnoid spaces. 

As Causes, may be mentioned : 

1. All influences which bring on general ansemia: blood-letting, 
haemorrhages, loss of vital fluids by too long-continued lactation 
or exhausting diarrhceas, especially summer-complaint; long-con- 
tinued fevers, hepatization of the lungs in weakly persons from 
the constant wasting away of blood and muscles; and starvation, 
which cuts off all recuperation of the lost vital fluid. 

2. Congestion or fluxion of blood to other organs. So may Junod's 
cupping-boot, an instrument which has been invented in imita- 
tion of the cupping-glass, to be applied to a whole limb, in order 
to cause an artificial afflux of blood into it, when used incau- 
tiously, produce anaemia in the brain, and for the same reason 
do we find persons of weakened activity of the heart faint more 
easily in a standing than in a lying position, because then the 
propelling force is not sufficient to overcome the natural gravity 
of the blood. We may add the effects of "shock," where, accord- 
ing to H. Fischer's theory, a reflex paralysis of the vasomotor 
nerves, especially the splanchnic, causes a collection of blood in 



34 BRAIN. 

large quantity in the distended vessels of the abdominal cavity ; 
the fainting away sometimes after the sudden expulsion of the 
foetus, where the hitherto compressed abdominal vessels fill 
quickly after the compressing cause is removed; the fainting in 
consequence of too rapid withdrawal of ascitic fluid for the same 



3. Compression or obstruction of the carotid or vertebral arteries — 
by artificial ligation, tumors or emboli, which prevent the normal 
afflux of blood to the brain. 

4. Spasmodic contractions of these vessels, as is evident in emotions 
of the mind, from which not only paleness of the face, but also 
swooning and unconsciousness may result; nervous apoplexy of 
some writers? 

5. Exudations, extravasations, tumors, depressions of the skull, 
whereby the internal capacity of the skull becoming diminished, 
the necessary supply of blood to the brain is impossible. 

Anaemia, when it consists in a deficiency of arterial blood in 
the brain, is caused by 

6. All those states of the system which prevent the normal oxygeniza- 
tion of the blood, such as different heart and lung diseases. It has 
been shown by Kussmaul and Tenner that by sudden suppres- 
sion of respiration, whereby the blood ceases to receive oxygen, 
the same symptoms are produced which a depletion will bring on. 

In accordance with these causes the Symptoms vary. In case 
of sudden depletion we have: sudden paleness of face with cold 
perspiration on forehead; gaping; slow breathing; ringing in 
the ears; dimness and flickering before the eyes; nausea, even 
vomiting; fainting away, which may be attended or followed by 
epileptiform convulsions. 

In the gradual development of anaemia the symptoms differ in 
individual cases more widely; all, however, are characterized by 
a great paleness of the face. The cerebral disturbances take 
either the form of depression (mental torpor, drowsiness, somno- 
lence, coma), or excitation (restlessness, sleeplessness, delirium, a 
condition mostly observed in cases caused by starvation, and in 
persons whose general state of anaemia is excessively aggravated 
by exhausting diseases or loss of blood). Vertigo is frequently 
present and headache occasionally. Specks and dimness before 
the eyes is common, and commoner still the ringing and buzzing 
in the ears; total amaurosis is rare. As regards the motor appa- 
ratus, we have either great weakness of all the muscles amount- 



AN.EMIA. 35 

ing to temporary paralysis, or epileptiform convulsions. The 
latter rarely happen in the gradual form, while the first, at least 
as general weakness, is present in almost all cases. 

The anasmia consequent upon summer-complaint was first and 
well described by Marshall Hall, who appropriately named it 
hydrocephaloid, on account of the great similarity of its symptoms 
to those of hydrocephalus acutus, and by him was divided into 
two stages — the irritable and torpid. 

In the first the children are restless; throwing themselves about 
in bed; starting frequently in sleep, and giving piercing shrieks; 
they grate their teeth ; their face looks red ; the pulse is frequent, 
and the skin hot; and spasms even may occur; thus making the 
whole resemble very much an acute attack of hydrocephalus. 

In the second stage, however, the children collapse, become 
apathetic; do not look at objects held before their eyes; their 
eyelids are half closed; pupils do not react against the light; 
their respiration becomes irregular; pulse very frequent and 
small; they gradually grow cold all over, first in the face; and, 
in fatal cases, they die with symptoms of coma. 

THERAPEUTIC HINTS.— In the first place, where the patient 
suffers with general ansemia, we ought to provide for him a diet 
which will best supply the lost vital fluids. Especially in sum- 
mer-complaint, wine and mutton-chops often do more good than 
medicine. Beef-tea, which principally consists of Potassa combi- 
nations, produces, according to Pfliiger's experiments in small 
doses, an increase in the frequency and force of cardiac contrac- 
tions; in large doses it acts as a poison, causing death by appa- 
rent paralysis of the heart. It ought to be used, therefore, with 
great caution. 

In the second place, where the heart's impulse has become 
weakened, we ought to take care that the patient should lie quiet 
in a horizontal position, not to allow him to leave the bed too 
soon, or even to rise for the purpose of using the chamber. 

The special treatment must be dictated by the conditions of 
each case; success is possible only when we take each case'as a 
"unicum," and search for its corresponding remedy in the Materia 
Medica. The symptoms indicating the remedy may lie entirely 
outside of the group of those symptoms which constitute the 
diagnosis. 

In general, however, the following remedies -may be mentioned 



3G BRAIN. 

as the most important in antemic states after loss of vital fluids: 
Calc. carb., Carb. veg., China, Kali carb., Mercur., Nux vom., 
Phosphor., Phos. ac, Pulsat., Sepia, Silic., Staphis., Sulphur. 

Dizziness, vertigo, better in a horizontal position, after eating; 
worse in the morning, and in the open air; complaint of old 
people: Ambra, Baryta c., Graphit., Lycop., Phosphor., Silic. 

Delirium in consequence of great loss of blood: Arnic, Arsen., 
Ignat., Laches., Lycop., Phosphor., Phosph. ac, Scilla, Sepia, Sul- 
phur, Verat. 

Convulsions in consequence of loss of blood: Arsen., Bellad., 
Calc. carb., Cina, Conium, Ignat,, Lycop., Nux vom., Pulsat., 
Sulphur, Verat. 

Summer-complaint will find particular mentioning under the 
head of abdominal disorders. 

Hyperemia 

Of the brain is that state in which it is overcharged with blood, 
either by aetivc congestion, rush of blood, or fluxion to the brain, or 
by star/nation of blood in the brain, passive hyperssmia, or Injperamia 
by stasis. 

Post-mortem examination frequently reveals a large quantity 
of blood in the vessels and sinuses, especially of the dependent 
parts of the cranial cavity. This may be a mere post-mortem 
result, since in other cases nothing of the kind is to be seen. 
The gray substance appears swollen and darker than usual: the 
white substance presents, in exceptional cases only, a reddish 
hue. The subarachnoidal mashes contain no fluid. 

In chronic cases the blood-vessels are almost always dilated; 
the substance of the brain is atrophied, and the subarachnoid 
spaces are filled with a large quantity of fluid, especially in the 
bodies of drunkards. 

In some cases, however, post-mortem examination does not 
reveal any such objective signs. On the contrary, the brain 
appears entirely empty of blood, although during life every 
symptom pointed to hyperemia. This fact has not yet been 
fully explained, and shows that appearances in the dead body do 
not always clearly reveal what has been going on in the living. 

Here the question may be asked : Is hyperemia possible at all'? 
As the brain is encased in an unyielding capsule, how can more 
blood enter than there is flowing off? To answer this question 



HYPEREMIA. 37 

Ave have to point to the cerebro-spinal fluid as a means of regu- 
lating the intra-cranial circulation. This fluid easily recedes 
when the cerehral vessels hecome distended and enters again 
whenever the pressure subsides, and thus we find it always absent 
when there is a greater afflux of blood, and present in considera- 
ble quantity within the meshes of the textus cellulosus sub- 
arachnoidealis, where there is an ansemic state of the brain. 
Only when the brain is atrophied, there is also an increase of this 
fluid besides hyperemia; and it is wanting again even if there be 
anaemia present, when the room of the skull is filled by tumors 
or effusion in the ventricles. As still other means for the regu- 
lation of the inti'a-cranial circulation recent researches consider: 
the perivascular lymph-spaces, the thyroid gland, the peculiar 
arrangement of the cerebral sinuses and the mechanism of the 
circle of Willis. 
Congestion takes place — 

1. In consequence of an undue activity of the serous membranes 
which, enveloping the brain, act like a suction-pump within the 
skull. This seems to be the condition of those persons Avho are 
subject to "rush of blood to the head." 

2. In consequence of obstructions to the flow of blood to other and 
different portions of the body, whereby it is diverted with increased 
force towards the brain. We see examples of this condition in 
compression of the aorta abdominalis by tumors, effusions, or 
enlarged abdominal viscera; in the contraction of the capillaries 
of the skin during the chilly stage of intermittent fever; and in 
the suppression of menstrual and haemorrhoidal discharges. 

3. In consequence of dilatation of tlie capillaries within the brain ; 
generally the result of the abuse of opium and alcoholic drinks 
and other narcotic substances ; of the exposure to the rays of the 
sun; of long-continued irritation of the brain by mental over- 
exertion. 

4. In consequence of paralysis of vasomoforic nerves. For example : 
after cutting through the cervical portion of the sympathicus Ave 
find that the blood-vessels of the corresponding side dilate. So 
have also certain emotions similar effects; by them the normal 
innervation of the Avails of the vessels is altered, they dilate and 
thus convey a larger mass of blood. This, may be the key for 
the explanation of some sudden deaths which ensue in conse- 
quence of violent mental emotions, fright or joy. 

Stagnation or hyperemia by stasis may be caused — 



38 BKAIN. 

1. By compression of the jugular veins from strangulation; by 
goitre, glandular tumors in the neck, or by aneurism of the aorta 
pressing upon the vena cava descendens. 

2. By violent expiratory movements, as take place during violent 
fits of coughing, straining, and the blowing of instruments; to 
which also belongs Dr. Bonwill's method of producing a transient 
state of anaesthesia for the purpose of drawing teeth and perform- 
ing minor surgical operations, by causing the patient to make 
rapid and deep inspirations. 

3. By diseases of the heart; such as tricuspid insufficiency, 
stenosis of the venous orifice, and insufficiency of its valves. 

4. By some lung diseases, as emphysema, extensive pneumonia, 
cirrhosis, and large pleuritic exudations; also diseases of the 
larynx, such as croup, oedema of the glottis and presence of 
foreign bodies. 

The Symptoms of hypersemia are best arranged under two 
heads, in accordance with its two stages: that of excitability and 
depression. 

To the first belong headache, sensitiveness to the light, noise 
and touch; flickering before the eyes; singing and ringing in 
the ears; pain and formication in the flesh; restlessness; jerking 
and automatic motions of the limbs; grating of the teeth; con- 
vulsions; dizziness; hallucination; sleeplessness and vivid dreams. 

To the second, the stage of depression, belong insensibility to 
light, noise or pressure. In this stage also the limbs go to sleep, 
lose their mobility, and feel heavy as lead; the pupils become 
dilated; the pulse frequent, and the respiration quite slow, irreg- 
ular, or snoring; and there is frequent vomiting. 

These are the general symptoms which vary, however, greatly 
in individual cases. In some, signs of irritation predominate, 
such as headache, great sensitiveness of the senses, flickering 
before the eyes and ringing in the ears; restless, dreamful sleep; 
redness of face, injected conjunctiva, quick and full pulse. In 
some persons a cup of coffee or glass of wine brings on such a 
condition. In place of these external signs of hyperamiia there 
may be paleness of the face. In other cases, especially those of 
children during dentition, convulsive motions predominate, from 
the mei'e jerking, twitching of single muscles to general convul- 
sions with loss of consciousness, vomiting, constipation, contrac- 
tion of pupils, etc. Other cases are characterized by headache, 
sleeplessness, restlessness, a feeling as if they should go crazy. 



HYPEREMIA. 



30 



delirium, symptoms, mostly brought on by overexertion of the 
brain. In still other cases we find this mental irritation increased 
to mania and rage after exposure of the head to the rays of the 
sun and the abuse of alcoholic drinks, especially in such indi- 
viduals as use them periodically and then to excess. Still other 
cases are characterized by depression and paralytic symptoms, 
which it is often difficult and sometimes impossible to distinguish 
from apoplectic fits. 

THERAPEUTIC HINTS.— Rush of blood to the head indicates: 

Aeon., dry and hot skin; the patient is very restless and beside 
himself; cries and complains much; is impatient and full of 
anxiety. 

Amyl. nitr., heat, throbbing and feeling of intense fulness in 
the head; protruding, staring eyes, throbbing in the ears; flush- 
ing of the face, choking feeling in throat, along the carotids; 
tumultuous action of the heart. 

Apis, jerking, crying out in sleep; frightful visions with fear 
and trembling; drowsiness; apathy; if Bellad. did not help. 

Arnica, head hot, remaining body cool ; after a blow or fall. 

Aurum, heat and roaring noise in the head, fiery sparks before 
the eyes, worse after mental exertion; fearful and longing for 
death. 

Bellad., hot and red face, sparkling eyes, and dilated pupils; 
throbbing of the carotids; drowsiness with inability to sleep, or 
drowsy sleep with starting ; fearful mood ; symptoms are aggra- 
vated by motion, leaning the head forward, or lying down; by 
light or sounds. 

Bryonia, the patient feels as though his brain would burst 
through the forehead; nosebleed; puffed, red face; great irrita- 
bility and fits of anger. 

Calc. carb., the patient is worse in the morning, with puffiness 
of the face; palpitation of the heart after eating; swelling of the 
pit of the stomach; after mental overexertion. 

Chamom., flickering before the eyes, often followed by headache ; 
stopped-up feeling in the ears with humming noise, often when 
awaking in the morning; exceedingly irritable, fits of anger; diz- 
ziness. Stagnation in the portal system with disposition to piles ; 
disagreeable feeling in the small of the back. 

China, the slightest touch of the scalp is unbearable; earthy 
color of the face. Headache worse from moving the eyes or 
shutting them ; better when sitting still in an upright position. 



40 BRAIN. 

Perrum, the face is hot and red, with swollen blood-vessels, 
accompanied by beating and humming in the head, and great 
sensitiveness of the scalp to touch. 

Gelsem., when, during dentition, children become drowsy, com- 
atose and convulsive; or when from the effects of heat there is 
dizziness, enlarged pupils, dimness of sight and a dull, confused 
headache spreading from the occiput over the whole head. 
Sleeplessness in delirium tremens. 

Glonoin., throbbing headache, great restlessness; inclination to 
run away; violent pulsations of the carotids; after exposure to 
excessive heat or cold. 

Hyosc, the patient is unconscious and delirious, with red, spar- 
kling eyes, and bluish-red face; or drowsy, jerks in sleep, cries out 
in sleep, grates his teeth ; subsultus tendinum. After Bel lad. 

Kali hydr., weakly constitution; disposition to tuberculosis; 
hammering pain in forehead; anxiety, restlessness, sleeplessness; 
sensation as though the head were larger; even if there is 
delirium and high fever. 

Nux vom., the patient is worse in the morning, in the open air, 
after the use of coffee, liquors, or opium ; with constipated bowels 
and suppression of hsemorrhoidal discharges. 

Opium, stupefaction ; snoring and rattling; slow breathing; slow 
pulse; sighing and moaning; bluish-red and bloated face; throb- 
bing of temporal arteries; cold perspiration in face; falling of 
lower jaw. 

Phosphor., heat on the top of the head, dizziness, buzzing and 
throbbing in the head; swelling under the eyes; and palpitation 
of the heart from mental emotions; emphysema. 

Pulsat, the face looks yellowish, and yet feels hot, with constant 
chilliness; worse in a warm room; better in the open air; no 
thirst; scanty or suppressed menses. 

Rhus tox., humming, formication and throbbing in the head : 
glistening redness of the face, and restlessness, which keeps the 
patient moving about. 

SpigeL, palpitation of the heart; violent headache: dizziness 
and stupefaction; frightfulness ; oppression of the chest. 

Spongia, pressing, beating in the forehead; redness of face, with 
anxious features; better in a horizontal position: goitre: heart 
disease. 

Stramon., unconscious and senseless: loss of sight and hearing: 
face turgescent; convulsive motions of the head: wild or stupid 



HYPEREMIA VERTIGO. 41 

expression; great thirst with hydrophobia; or furibund delirium; 
greatest restlessness, wants to run away; sleeplessness. 

Sulphur, flying heat in the face; diminished hearing; burning, 
throbbing and buzzing in the head; better in the room, worse in 
the open air; in hsemorrhoidal complaints; and after the sup- 
pression of cutaneous eruptions. 

Ver. vir., sense of fulness, weight, distention in the head; giddi- 
ness, intense headache, throbbing arteries, stupefaction ; double, 
partial, luminous visions; nausea, vomiting; tingling, numbness 
in limbs; mental confusion, loss of memory, convulsions or pa- 
ralysis; during dentition; congestion from alcoholic stimulants. 

In summing up as to the various causes, the following scheme 
may be of some use, although it must not be considered as ex- 
hausting the subject. 

From mental emotions: Aeon., Amyl. nitr., Coffea, Ignat., Opium, 
Ver. vir. 

From mental overexertions: Aurum, Calc. carb., Nux vom., 
Phosphor., Sulphur. 

From teething: Aeon., Bellad., Calc. carb., Gelsem., Ver. vir. 

From suppression of hemorrhoidal discharges: Aeon., Chamom., 
Calc. carb., Carb. veg., Nux vom., Pulsat, Sulphur. 

From suppressed or scanty menses: Aeon., Apis, Bellad., Bryon., 
Calc. carb., Carb. an., Chamom., Conium, Dulcam., Ferrum, 
Graphit., Laches., Lycop., Merc, sol., Phosphor., Pulsat., Sepia, 
Silic, Sulphur, Veratr. 

From hypertrophy of the left heart: Aeon., Aurum, Cact. grand., 
Glonoin, Jodium, Kalmia, Spigel, Spongia, 

From insufficiency of the tricuspidalis: Bellad., Hyosc, Kali carb., 
Pulsat. 

During a chill: Aeon., Arnica,' Arsen., Bellad., Bryon., Calc. 
carb., Chamom., Digit., Ferrum, Hyosc, Ipec, Lycop., Mercur., 
Nitrum, Rhus tox., Sabad., Stramon., Sulphur, Veratr. 

From cdcoholic drinh: Aeon., Arsen., Calc. carb., Gelsem., 
Laches., Nux vom., Pulsat., Opium, Ver. vir. 

From straining : Aeon., Arnic, Bryon., Rhus tox. 

In chronic cases: Aurum, Calc. carb., Ferrum, Phosphor., 
Spongia, Sulphur. 

Vertigo. 

This symptom so conspicuous in anaemia, as well as in hyper- 
semia of the brain and in many other quite different affections of 



42 BRAItf. 

the body, has been denned by F. Memeyer as "a hallucination, 
consisting of the vivid conception of a motion of the body or of 
the surrounding objects, which the patient imagines to see and 
to feel, although he himself and his surroundings are in perfect 
rest." This definition is undoubtedly defective. For if vertigo 
is a hallucination, colic and all other subjective symptoms would 
be. Kafka calls it "a sensation of seeming motion which, by 
full consciousness, is perceived to take place in oneself or in the 
surrounding objects, with a feeling of loss of balance of the body 
and an uncertainty in standing, walking, sitting or lying." He 
considers it as a peculiar affection of motor-nerves, caused either 
by the brain itself, or the cranial nerves or by some more remote 
ganglia or organs." This definition, too, wants correction. Let 
us consider a simple instance in which vertigo is produced in 
even quite healthy persons — the swift swinging around of the 
entire body in a circle. If we observe closely, we find that ver- 
tigo in such a case is experienced not exactly during but at the 
sudden cessation of this motion. Why? Because so long as the 
whole body moves in a certain direction, all its parts move with 
it, fluids and solids, just as you may, by means of a sling, swing 
water in an open vessel in a circle without losing a single drop; 
but stop its motion suddenly and vessel and water will fly to the 
ground. So when the rotatory motion of the body is suddenly 
stopped, the fluid parts of the body and especially the large col- 
lection of blood in the cranial sinuses must necessarily recoil and 
assume a motion in disharmony with the whole body. It is this 
commotion of the blood in the brain which is immediately felt 
and designated by the name of vertigo. Vertigo, then, we should 
say, is the sensation of an actual commotion of the blood within 
the cranial cavity. This separate, disharmonial motion affects 
the sensient nerves and is perceived by the sensorium, from 
which again, by reflex action, motor nerves are excited, hence 
the tottering, reeling or grasping for something, or the falling 
down, when the undue excitement should bring on momentary 
unconsciousness, or the seeming motion of the surrounding ob- 
jects, etc. Thus we experience vertigo by all such motions of the 
body which are capable of producing a disharmonial motion of 
the blood within the cranial cavity, for instance, concussions of 
the body, dancing, bending forward or backward and rising, 
looking up or turning around quickly, swinging, sailing in ves- 
sels, etc. In regard to this latter it is a known fact, that one 



VERTIGO. 43 

gets seasick more readily on the lakes than on the ocean, because 
here the waves are shorter and more irregular than there, caus- 
ing a much more abrupt shaking of the passenger. When the 
body of a passenger is thus suddenly concussed, the blood in the 
sinuses cannot follow the sudden motions of the solid parts of the 
body in equal tempo; it is caused to vibrate in a tempo of its 
own, and this perturbation or commotion of the blood within the 
sinuses we feel as vertigo, or seasickness. Seasickness, therefore, 
does not abate until a person exposed to being constantly tossed 
about, becomes so thoroughly accustomed to the motions of the 
ship, that he unconsciously anticipates all the pranks which the 
unruly waves may play and harmonizes his motions with those 
of the vessel, preventing in this way any further perturbation of 
the blood within the cerebral sinuses. 

We have still to consider, however, other cases in which the 
unwonted motion of the blood within the cranial cavity is not so 
apparent a cause of vertigo as in the above mentioned instances. 
We also see vertigo produced under circumstances where such 
external concussions do not exist, as for instance by exudations 
within the brain, by tumors, tubercles, cancer or atheromatous 
degeneration of the cerebral blood-vessels, by great heat, me- 
phitic exhalations, aromatic odors and above all by almost every 
one of the drugs proved, with but few exceptions, for instance, 
Fluor, ac. Does our view hold good even in these cases ? 

In the first place we should say that concussions of the body, 
swinging, sailing, etc., do not produce vertigo in all persons. 
There must be, then, something deeper still to be considered be- 
fore we shall be able to fully understand the phenomenon of ver- 
tigo. And here I must draw attention to the arachnoid mem- 
brane which envelopes the brain and, like other serous mem- 
branes, is a shut sac. The functional action of this and all other 
like membranes may^ according to C. Hering, be likened to that 
of a suction-pump. When excited it draws a greater amount of 
blood into the cranial cavity than when in a state of relaxation. 
It is thus one of the principal means by which the circulation 
within the brain is regulated. But its influence extends not 
only over the amount of blood in the brain, it at the same -time 
controls more or less also the movement of the blood within the 
sinuses. The more healthful its action, the more readily it will 
regulate this flow and check any undue commotion, while during 
a relaxed state the slightest functional or mechanical cause may 



44 BRAIN. 

bring on perturbation, and this explains why some persons do 
not feel dizzy from turning, dancing, sailing, etc., when others do. 
And if we further take into consideration that exudation, tumors, 
tubercles, etc., in short various kinds of morbid processes within 
the brain, and also numerous drugs when taken during a state 
of health, must necessarily affect the arachnoid, either excite or 
relax its action, we have sufficient reason to assume that in either 
case the regular flow and circulation of the blood through the 
sinuses must also be more or less disturbed, which would account 
for the feeling of vertigo in all such cases. We come thus to the 
conclusion that vertigo, even in those instances where its course is 
not so apparent as in cases of external concussion, etc., is never- 
theless the feeling of an undue commotion of the blood within 
the sinuses, which is produced, or which, at least, is not checked 
by the arachnoid in consequence of its own excitation or relaxa- 
tion. 

Authors have spoken of hypereemie or congestive, of ana?mic, 
nervous toxic, epileptic, stomachic and psychic vertigo. All these 
different designations have reference to morbid affections with 
which vertigo is frequently associated, or which are the cause of 
disturbance in the circulation of the blood within the brain. 

Vertigo may appear under the most varied conditions: in rest 
or motion; on stooping or rising, or turning the head: during 
lying, even in sleep; from dazzling or streaked light: from the 
quick motion of objects before the eyes, in passing a railing or 
riding in the cars; by the sight of an unpleasant object — a bleed- 
ing wound, a surgical operation, etc. : by looking down from a 
height or looking up to a height, and in many more other ways. 
It is rarely observed in children, more frequently in adults and 
oftenest in old age. 

Its Prognosis depends entirely on the nature of those morbid 
processes with which it is connected. " 

THERAPEUTIC HINTS.— Aeon., congestive: heat and pain in 
head; red face; nosebleed: pulsation of carotids. When trying 
to sit up in bed, the patient tumbles over: he is afraid to rise lest 
he might fall again; must take hold of something. Stoppage of 
menstrual flow from cold, fright, fear or vexation; after habitual 
blood-letting. 

Agar., heaving and whirling of objects around: tendency to fall 
forward; partial amaurotic blindness, with floating muscae and 



VERTIGO. 45 

vibrating spectra; partial numbness of left side of tongue. Hy- 
persesthesia of smell; unusual sensitiveness to cold air; hysteria 
and nervousness brought on by exciting debate or by' protracted 
mental application; by overexertion of the eyes; by strong light 
of the sun. 

Anac, great forgetfulness ; dim sight; on stooping and rising 
from stooping, he feels as if he were turning to the left. 

Apis, headache; heat in head; red face; nosebleed; pulsation 
of carotids. Worse when sitting than when walking; extreme 
when lying down and closing the eyes. 

Arg. nitr., chronic, as if every thing were turning around; 
dyspnoea; palpitation of the heart; paralysis of diaphragm; left 
half of body very weak; left arm or hand heavy and numb; 
trembling weakness brought on by walking with shut eyes; by 
walking in streets with high houses, which seem to fall upon him. 

Arnica, as if every thing were turning around or falling upon 
him: ears feel stopped up when speaking, swallowing or blowing 
the nose; better in lying, disappearing on stooping; after bodily 
overexertions or injuries. 

Ast. rub., single case by Petroz. Man has fits of vertigo, as if 
the head were suddenly concussed; head always hot, face red, 
pulse hard, contracted and frequent; obstinate constipation by 
good appetite; constant contractions of the muscles of the lower 
limbs; gait uncertain, because the muscles do not obey the will; 
restless and sleepless. 

Arsen., hyperesthesia of hearing; burning in stomach and 
vomiting; malarial with loss of appetite, vomiting and head- 
ache; dilatation of right ventricle, emphysema, bronchial ca- 
tarrh ; sleeplessness. During pregnancy, with pale, bluish, puffed 
face, blue lips and nails and undulation of jugular veins. 

Aur. mur., hypertrophy of left ventricle, with great congestion 
towards head and face. 

Bellad., acute and chronic; revolving; staggering, reeling, 
must take hold of something ; transient unconsciousness ; anxi- 
ety; shuns people, is bashful ; head appears double; sees frightful 
things on shutting the eyes. Headache pressing, throbbing ; 
gnawing pain in the bones of the skull, face and teeth ; rush of 
blood to head and face ; sometimes sensation as of icy-cold water 
streaming down from head to face ; flickering and dimness be- 
fore eyes ; hyperesthesia of eyes ; enlarged pupils ; buzzing in 
ears, with dulness of hearing ; nosebleed ; pulsation of carotids ; 



46 BRAIN. 

loss of appetite and vomiting ; stitching pain in chest ; slow 
pulse , weakness and trembling of limbs when walking ; drowsy 
in daytime, sleepless at night; hysteria and general nervousness; 
epileptic vertigo. Worse on rising from lying, sitting or stoop- 
ing; in standing; after eating. After typhoid fever; taking 
cold ; violent fright ; overexertion of the eyes, with muscse vol- 
antes ; from the smell of flowers, gas, etheric oils, turpentine, etc., 
with stupefaction. Some prefer Atrop. in some cases. 

Borax, a feeling as if pushed from right to left and somewhat 
forward ; on descending or being moved downward. 

Bovist, in the morning with loss of consciousness and pressing 
pain in head. 

Bryon., like whirling on sitting up, standing and walking; 
burning in stomach and vomiting ; distention, passage of offen- 
sive flatus, and constipation ; bronchial catarrh ; emphysema ; 
dilatation of right ventricle. After suppressed haemorrhoids ; 
bodily overexertion. 

Calc. carb., stupefying ; epileptic ; hyperaesthesia of eyes ; dim- 
ness of sight; abdominal congestion, distention, flatus, constipa- 
tion ; amenorrhcea, which has gradually developed ; climaxis, 
with flushes of heat and sweat ; hypertrophy of left ventricle, 
with congestion towards head and face ; hypochondria, hysteria 
and nervousness ; sleeplessness ; tuberculous disposition ; rha- 
chitis; scirrhous tumors. AVorse in morning, in walking out-doors, 
especially on suddenly turning the head, on stooping and ascend- 
ing. Brought on by mental overexertion ; by reading, fine sew- 
ing, etc. ; by sedentary life, high living, excess in ventre. 

Calc. jod., glandular swellings on neck, goitre. 

Carb. veg., venous stagnation in abdomen, flatus, constipation ; 
from sedentary life; mental exertion: high living; spirituous 
drinks, tea, coffee, tobacco, opium. 

Caustic, attacks at 11 o'clock a.m., with stitches in top of bead, 
pain in back and small of back when rising from a seat: on 
looking upwards, inclination to fall towards left side ; on stoop- 
ing, to fall backward. 

Chamom., fits of anger ; congestion in portal system : distention 
from wind. 

China, anaomic from loss of blood. or vital fluids; hysteria and 
nervousness. 

Coccul., intoxication, stupefaction; nausea, pressing and throb- 
bing in temples ; alternate going to sleep of either feet or hands ; 



VERTIGO. 47 

difficult speech ; distention of abdomen from wind ; constipation ; 
chlorosis. Worse on rising and after eating. 

Coffea, hysteria and nervousness ; sleeplessness. 

Conium, frequent drowsiness; on bending the head forward, 
heaviness in occiput; dimsightedness; nosebleed in spring; 
venous abdominal hyperemia and amenorrhcea; acrid fluor 
albus ; torpid urine with mucus ; climaxis, with flushes of heat 
and sweat ; rhachitis and swelling of lymphatic glands. 

Cyclam., dyspepsia; hyperesthesia of the cutaneous nerves of 
the extremities ; hysteria and nervousness. 

Ferrum, anemic from loss of blood. 

Gelsem., intoxication, confusion, headache; dimness of sight; 
dilatation of pupils ; general depression of system from heat. 

Glonoin., congestive ; forerunner of apoplexy ; intoxication and 
heaviness of head, with bending the head forward ; reeling, 
trembling , falling ; headache ; heat in head ; redness of face ; 
photophobia ; injection of conjunctiva ; flickering before the 
eyes; buzzing in the ears; pulsation of carotids. Worse on sit- 
ting up. 

Graphit., hyperesthesia of eyes; venous stagnation; constipa- 
tion ; incarceration of flatus. From overexertion of the eyes by 
reading, sewing, etc. 

Hepar, hyperesthesia of smell; decreased peristaltic motion; 
hard feces. 

Hyosc, stupefaction; depressing mental influences; hypochon- 
driacal ; from the smell of flowers, gas, etheric oils, etc. 

Ignat, epileptic; gastric symptoms ; gaping; abdominal conges- 
tion; flatus; tingling as of ants; jerkings; heaviness of right arm ; 
spinal affection; anemia; sleeplessness; hystery and nervous- 
ness. Worse from slightest motion of head, especially stooping. 
Brought on by depressing mental influences; fear, anxiety, fright. 

Ipec, malarial headache; loss of appetite and vomiting. In 
pregnancy, with pale, bluish, puffed face, blue lips and nails; 
undulation of jugular veins. 

Iodum, goitre; hypertrophy of left ventricle, with great conges- 
tion towards head and face; hysteria and nervousness. 

Kali carb., nausea and vomiting; after eating, with heat in head 
and red face; darkness before the eyes; sometimes one cheek hot, 
the other cold. Must lie down or he falls down. Before falling 
stitching pain in forehead, root of nose and eyes ; fatty degenera- 
tion of heart. 



48 BRAIX. 

Kali brom., goitre. 

Kali hydr., glandular swelling on neck ; rhachitis. 

Laches., epileptic; can't bear anything coming near him ; venous 
stagnation; constipation; flatulency; burning in stomach, vom- 
iting and diarrhoea. 

Lycop., head heavy; scathing, roaring and noises in head; fears 
to lose senses ; ebulitions from stomach to chest and head; he gets 
hot, face reddens, eyes water and become dim ; constant pain in 
back and small of back; venous stagnation in abdomen; disten- 
tion; constipation; incarcerated flatus. Worse on stooping; 
when drinking. 

Mercur., headache, nausea, loss of appetite ; in bed and out of 
bed; can't rise and sit up for fear of falling; must lie down; feels 
like swinging, lying in bed. Receded cutaneous eruption. 

Merc, corr., syphilitic tumors in the brain. 

Merc, jod., syphilitic tumors in the brain. 

Mezer., syphilitic affections of brain. 

Natr. mur., with feeling of fainting: periostitis of scull; dyspep- 
sia; abdominal congestion; flatulency: constipation; sup; 
hsemorrhoidal discharge. From sedentary life: depressing mental 
influences ; mental exertion : reading, sewing, etc. ; high living ; 
spirituous drinks, tea, coffee, tobacco, opium. 

Nitr. ac, climaxis; syphilitic taint. 

Nux vom., epileptic : malarial: revolving: sudden, like an elec- 
tric shock; before vertigo, drawing headache with heat in fore- 
head, yawning. Headache ; loss of appetite and vomiting : burn- 
ing in stomach after eating; dyspepsia; abdominal congestion; 
flatulency; constipation; haemorrhoids; hysteria and nervous- 
ness; hypochondriacs. Worse after dinner or eating: when 
stooping and rising; sometimes at nights, waking out of sleep. 
Brought on by mental exertion or sedentary habits: high living: 
alcoholic drinks; smoking, coffee, opium; from the smell of flow- 
ers, gas, etheric oils, etc., attended with nausea : suppressed flow 
of haemorrhoids. 

Opium, stupefaction as after intoxication: drowsiness: red. 
glossy eyes ; enlarged pupils ; dimness of sight : pale face : de- 
creased peristaltic motion, difficult defecation. Worse on sitting 
up in bed. After fright. 

Phosphor., revolving, as if he would fall; malarial; headache; 
weight and throbbing in forehead on waking: rush of blood to 
the head; hyperaesthesia of smell; loss of appetite; nausea, vom- 



VERTIGO. 49 

iting; burning in stomach; abdominal congestion with flatu- 
lency; during pregnancy pale, bluish, puffed face, blue lips and 
nails, undulation of jugular veins; hypertrophy of left ventricle 
with congestion to head and face; dilatation of right ventricle; 
fatty degeneration of heart; emphysema; bronchial catarrh; 
sleeplessness; atrophy of brain in old age; scirrhous tumors; 
periostitis of skull. Worse morning and evening; 'after eating; 
during sitting. Brought on overexertion of the eyes, attended 
with muscse volantes; by the smell of flowers, gas, etherial oils, 
turpentine, attended with fainting; by loss of vital fluids. 

Phospli. ac, hypochondriacs after excess in venere; climaxis 
with flushes of heat and sweat. 

Platin., overestimation of self. 

Pulsat, hot head; flickering before eyes; stitch pain in ears 
and tearing in head; pale face; painful crawling in stomach; 
tearing in limbs; shifting rheumatic pains; scanty, retarded or 
suppressed menses; sleeplessness; chlorosis. Worse when sitting 
and lying ; on getting up from a seat. Brought on after anxiety, 
fear and fright. 

Rhus tox., tipsy feeling; in aged persons; dilatation of right 
ventricle; emphysema; bronchial catarrh; worse in morning 
after rising, with uncertainty in walking, wants to be supported 
by a cane or another person; better from continued motion; 
worse on getting up from lying, on turning, stooping. Brought 
on by bodily overexertion. 

Ruta, overexertion of the eyes with muscae volantes; bodily 
overexertion. 

Sambuc, fatty degeneration of heart. 

Sanguin., vertigo during sleep. 

Sec. corn., hyperesthesia of cutaneous nerves, especially of the 
spine. 

Sepia, dyspepsia ; venous hypereemia in abdomen ; constipation ; 
flatulency; gradual developing amenorrhcea; hypochondriacs; 
climaxis with flushes of heat and sweat; sleeplessness. Worse 
when drinking. Brought on by mental overexertion ; excess in 
venere. 

Silic, stupefying; preceded by rush of blood to the head; op- 
pression of chest and pit of stomach. Headache; menses too 
early, too protracted, too copious; after menses, fluor albus; 
venous stagnation in abdomen ; constipation; incarcerated flatus; 
hypochondriacal; sleeplessness; tuberculous disposition; rhachi- 



50 BRAIN. 

tis; periostitis; scirrhous tumors. Vertigo during sleep. Brought 
on by overexertion of the eyes from reading, sewing, etc.; by 
excess in venere. 

Spigel., stumbling and falling as if intoxicated; pressing pain 
in top of head, worse from stooping, walking and talking; better 
when lying ; hypertrophy of heart ; feeling of fainting. 

Spongia, goitre; hypertrophy of heart. 

Staphis., hypochondriacal; depressing mental influences. 

Stramon., twitching in face ; spasm in chest ; spasmodic laugh- 
ing; worse at night on lying upon the side. 

Sulphur, constant feeling of wavering in head and body, as if 
swinging and as if the bed were not wide enough to hold him ; 
feeling of tightness in head, as if bound ; dimness of sight; venous 
stagnation, and feeling of fulness in abdomen, constipation, flatu- 
lency; suppressed hsemorrhoids; receded or suppressed cutaneous 
eruption; occasional itching after itch; periostitis. 

Tart, em., venous stagnation of abdomen with flatulency; during 
pregnancy pale, bluish, puffed face ; blue lips and nails, undula- 
tions of jugular veins. 

Therid., nausea with vertigo on closing the eyes, worse from 
noise and motion. 

Thuja, epileptic; hair dry and finger nails ribbed. 

Ver. alb., malarial with headache and loss of appetite; over- 
estimation of self ; hyperesthesia of hearing; burning in stomach : 
vomiting and diarrhea; venous stagnation in abdomen with 
flatulency; during pregnancy pale, bluish, puffed face, blue lips 
and nails, undulation of jugular veins; dilatation of right ven- 
tricle ; emphysema ; bronchial catarrh. Brought on by spirituous 
drinks, tea, coffee, tobacco, opium. 

Zincum, in the occiput, with falling to the left when walking. 

Zingib., with heavy limbs. 

The following scheme was prepared by Kafka relating to ner- 
vous vertigo : 

Vertigo in the morning: Calc. carb., Xux vom., Phosphor.. Rhus 
tox., Natr. mur. 

in the evening: Bellad., Pulsat.. Cyclam., Sepia. Zincum. 

Laches. 

when lying down: Pulsat., Cyclam., Arsen.. Aurum. 

when rising: Xux vom., Phus tox., Coccuh, Laches.. Conium. 

when walking: Pulsat., Lycop., Conium, Capsic. Phosphor. 

when stooping: Calc. carb., Bryon., Sepia, Spigel. 



VERTIGO. 51 

Vertigo with an empty stomach : Phosphor., Iodum., Calc. carb., 

China. 
after eating: Calc. carb., Nux vom., Natr. mur., Phosphor., 

Lycop., Sepia. 

after sleeping: Phosphor., Sepia, Nux vom. 

in the fresh air: Nux vom., Silic, Coccul. 

in the room: Silic, Agar., Arsen., Pulsat. 

before the menses: Calc. carb., Pulsat., Sepia, Yer. alb. 

during the menses: Phosphor., Hyosc, Graphit., Lycop. 

after the menses: Nux vom., Phosphor., Graphit. 

Amelioration by motion: Rhus tox., Pulsat., Capsio, Cyclam., 

Lycop. 

by rest: Nux vom., Natr. mur., Bellad., Colchic. 

Revolving vertigo : Phosphor., Nux vom., Bryon., Arnica. 
Stupefying vertigo: Calc. carb., Silic, Bellad., Hyosc. 
Staggering vertigo: Aeon., Rhus tox., Nux vom., Platina. 
Vertigo with trembling and uneasiness: Phosphor., Calc. carb., 

Ignat., Arsen. 
with fainting: Phosphor., Nux vom., Natr. mur., Arsen., 

China. 

with vomiting: Nux vom., Ipec, Ver. alb., Arsen., Pulsat. 

Vertigo with inclination of falling forward: Phosph. ac, Graphit., 

Cicut. vir., Spigel. 
with inclination of falling backward: Rhus tox., Nux vom., 

Bryon., China. 
with inclination of falling sideways: Silic, Sulphur, Ipec. 



Sea-sickness. — Even here we have to study the peculiarities of 
the single case. 

Apomorphia, nausea without any apparent signs of gastricism. 
Dr. Skinner gave it with success. 

Borax, perhaps never given, should be tried on account of its 
symptoms of aggravation on downward motion. 

Calc. carb. may be indicated by its aggravation on upward mo- 
tion. 

Coccul. is perhaps the oldest remedy recommended in sea-sick- 
ness. Nausea with tendency to faint. 

Colchic., excessive sensitiveness of smell against cooking. 

Nux vom., headache; gastric symptoms; constipation. 

Opium, great sleepiness ; constipation. 



52 BRAIN. 

Sepia, headache; desire for sour and refreshing things. 

Petrol, has proved beneficial very often. 

Pulsat, drowsy, thirstless; dizzy, especially on getting up from 
a seat ; feels better on deck. 

Some persons are greatly benefited by applying a piece of 
blotting paper, soaked in rum or brandy, upon the pit of the 
stomach. 

In all cases it will be well to exert the will-power in order to 
gain command over the body against the motions of the vessel 
and to harmonize its motions with that of the ship. 

Sleep, Stupor, Insomnia. 

The fluids and tissues of the body are constantly undergoing 
change by the ceaseless activity of its various parts as an organ- 
ized entity. Every voluntary or involuntary motion of the mus- 
cles, the action of the different glands, the working of the entire 
nervous system is attended with a continuous retrograde meta- 
morphosis of constituent elements. All this must, at certain 
periods, inevitably result in exhaustion. The consequent neces- 
sity for reparation of the lost elements manifests itself in active 
assimilation of new material from what has been prepared by di- 
gestion ; in other words the conscious activity of the cerebro-spinal 
system gives way to the unconscious activity of the sympathetic 
system — we fall asleep. Sleep, therefore, in its real nature con- 
sists in the predominant activity of the sympathetic system over 
that of the cerebro-spinal. For this reason, we find during sleep, 
as Durham in his "Physiology of Sleep" observes, "a notable in- 
crease of blood in the stomach and other abdominal viscera,"' 
which is drawn there by the increased action of the assimilating 
system; for wherever there is greater activity there is a greater 
afflux of blood. But this heightened action of the assimilating 
system has also another effect; it subdues all other activities. 
Mentally we become unconscious, partly from actual want of ex- 
citing elements which have been consumed during waking life. 
and partly from the withdrawal of exciting elements by the in- 
creased action of the assimilating organs; we find, therefore, 
physiologically corresponding, less blood in the brain, as has been 
demonstrated by Durham, Hammond and others. Bodily our 
voluntary muscles subside into inactivity and the amount of 
work done by the excretory organs is equally lessened: we find. 



SLEEP, STUPOR, INSOMNIA. 53 

physiologically corresponding, respiration as well as circulation 
decidedly slower than during waking life. 

All this is the necessary consequence of the increased action of 
the assimilating S} r stem. For it is impossible that all our activi- 
ties could be excited at the same time in an equal degree. We 
see this clearly portrayed in the action of our mental life. Even 
during our waking periods conscious excitement belongs only to 
a very small portion of what we mentally possess; the bulk of our 
possessions lies dormant. Consciousness shifts from one mental 
modification to another, sometimes swiftly even tumultuously ; 
or only slowly or evenly, but always involving only parts and 
portions of our entire mental acquisitions. The same holds 
good when we consider man mentally and physically as one 
whole. During the predominant activity of his cerebro-spinal 
system, the sympathetic system is in comparative rest, while the 
latter subdues the former, when the primary forces have been 
consumed and a new supply has to be prepared by its action. 
How great the force is with which the assimilating process 
assumes its ruling, we all have repeatedly experienced ; the eye- 
lids droop, the sounds grow indistinct and irresistably we fall 
asleep. The restitution of vital forces must be done and during 
that process all other activities must partially or totally cease. 
It is erroneous, therefore, to say that "the state of comparative re- 
pose which attends upon this condition (sleep) allows the balance 
to be restored" (Hammond), since in fact this restitution or more 
definitely expressed, the assimilating process does not allow the 
accustomed action of the mind, brain and other organs. Uncon- 
sciousness, partial or total, is a necessary concomitant of sleep, not 
its essential nature, just as the comparative repose of the volun- 
tary muscle and excretory organs is the natural consequence of 
the heightened activity of the assimilating system. As long as 
either reigns, the other must be silent. And as an increased 
activity always causes an increased circulation and vice versa, it 
is erroneous to say that the loss of consciousness, total or partial, 
during sleep be due to the lessened circulation of blood within 
the brain, since in fact the comparative inability of the mind 
(unconsciousness) and the consequent inactivity of the brain as 
its condition, is the cause of this lessened circulation. Being not 
needed in the brain and all other organs- which are under the 
control of the cerebro-spinal system, the circulation slackens here 
and increases where a heightened activity calls for it, i. e., in the 
assimilating system. 



54 BRAIN. 

Playfair thinks that sleep is due to "a diminished supply of 
oxygen to the brain" {Northern Journal of Medicine, No. 1, 1844, 
p. 34; see Hammond on sleep, p. 30); and Preyor holds the 
opinion "that the oxygen during sleep is used up in a different 
manner than in the waking state. During exercise of the brain, 
as well as of the muscles, a kind of peculiar material, so-called 
"material from weariness" forms, which accumulates in quanti- 
ties corresponding to the intensity of the activity, is very oxid- 
able, and which lays hold of the oxygen during sleep, and thus 
becomes oxidized "( Wiener Freie Presse, Sept., 1876 ; North. Am. 
Journal, Febr., 77, p. 349). These views are just as valuable 
and correct as the idea of a diminished circulation of blood in 
the brain during sleep. For oxygen is certainly a necessary con- 
stituent to healthy blood and of the consequent activity of any 
kind. But when, according to Pettenkofer's experiments, the 
system accumulates during sleep much more oxygen than dur- 
ing its waking state, one cannot clearly see why an increasing 
acquisition of oxygen should just induce sleep, which is supposed 
to be due to a diminished supply of oxygen. Here as elsewhere 
again a condition is taken for the cause. The cause lies in the 
hightened action of the assimilating system, which again re- 
plenishes what during the activity of the cerebro-spinal is needed 
and consumed. 

It will not do, to oppose this truth by reminding of the fact 
that an x artificial interruption or suppression of the circulation 
within the cranium by compressing the carotids will cause un- 
consciousness ; for we have never stated that healthful circula- 
tion of the blood be not required for the functional activity of 
the brain, nor that a healthy brain be not a necessary condition 
for the legitimate exercise of the mind. A certain amount of 
healthy blood within the brain is a necessary condition for its 
successful operation, but is a condition the came? Still, if it 
might be allowed to say that a certain amount of opium, chloral, 
carbonic oxide, etc., causes stupor (unconsciousness^, why should 
we not likewise consider the lessened circulation of blood during 
sleep as the cause of its attending unconsciousness ? Because 
thereby we woidd not at all explain the lessened afflux of blood 
to the brain, and the question would still remain: "What lessens 
the circulation in the brain during sleep? And we have stated 
the cause : it is the reduced activity of the brain in consequence 
of the hightened activity of the assimilating system. "Wave-like 



SLEEP, STUPOR, INSOMNIA. bO 

do these activities interchange, like ebb and flood, and where the 
one is in the ascendency, the other has to go down. The neces- 
sity of each regulates their periodicity. In the new-born child 
the vegetative sphere is yet so predominant, that in the first six 
weeks, if well, the child sleeps all the time with but short inter- 
ruptions. Gradually, however, as its mentality widens, sleep be- 
comes shorter, until it is reduced to a certain space of time neces- 
sary for the assimilation of new forces required for action of the 
cerebro-spinal system. Worriment of mind, great passions, etc., 
may banish sleep for a considerable length of time, that is, may 
subdue by its strength the activity of the vegetative system, 
but not without an adaquate cost to the whole organism, and yet 
finally even the strongest passion will have to yield to the still 
greater power of recuperating necessity. 

Stupor, Coma, or whatever a state of unconsciousness, resembling 
deep sleep, may be called, is no sleep. It is caused by a violent 
interference with the conditions necessary for a normal action of 
the brain. Such Causes are various remedial agents, like 
opium, chloral, carbonic oxide, alcohol and others, which vitiate 
the blood; or different blood-poisoning diseases, like typhus, 
scarlatina, uremia and others ; or haemorrhage within the brain 
(apoplexy), which compresses the organ so as to make it unfit for 
a successful operation of the mind. Sleep and stupor differ, 
therefore, in this that the first is the natural consequence of the 
predominating activity of the assimilating system, while the 
latter is induced by a direct violence to the brain ; there health, 
here disease is represented. The approach of sleep is favored by 
everything which either depresses mental life (cuts off the supply 
of exciting elements, especially fatiguing mental toil, and also 
listless reverie, want of external excitement), or which gives in- 
creased impetus to the bodily act of assimilation, such as super- 
abundance of food, hot drinks, great bodily exhaustion, loss of 
blood, etc. Excessive cold does not produce sleep, but stupor, like 
excessive heat. In both cases the effect is congestion towards the 
brain, which renders this organ unfit for the successful exercise 
of mental action. 

If on the contrary by excessive mental strain, as we find it not 
unfrequently with business men, too eager students, or after great 
trials, sorrow, anxiety, night- watching, etc. — the assimilating pro- 
cess has been unduty restricted for a greater length of time — 
Sleeplessness (Insomnia) is the natural result. Mental and conse- 



56 BRAIN. 

quently cerebral activity so overbalances the process of appropria- 
tion, that the assimilating system at last becomes weakened, and 
losing its connative force, leaves the work undone which it is de- 
stined to do. This necessarily must prove destructive to the 
entire organism, and cause bodily an overwrought condition of 
the brain (relaxed and enlarged blood-vessels), while the mental 
activities gradually confine themselves to fixed ideas or uncon- 
trollable combinations, until at last but an insane wreck of a 
formerly well-balanced constitution is left. 

But there are also a number of Bodily Causes which induce 
sleeplessness; they all may be summed up under the one head : 
Whatever interferes ivith the process of assimilation. The number of 
such disorders is large, and their pathological specification will 
appear in the course of this work. In general most fevers have 
this effect, and among the daily used beverages, coffee and tea 
are the most prominent, as they retard according to physiological 
experiments, the process of waste and repair in the tissues. 

THERAPEUTIC HINTS.— It is one of the most favorable signs 
when soon after the administration of a remedy, a natural sleep 
ensues. By no means ought such sleep to be interrupted. While 
it lasts, nature replenishes and rebuilds what has been spent and 
wasted. It does more good than a repetition of medicine, by 
which indeed the first beneficial effect might be destroyed ; the 
remedy which induces it will quietly work on for the benefit of 
the patient; it is the remedy. This rule applies only to natural 
sleep. In case of Drowsiness, Stupor, etc., medicine must be re- 
peated just because of this state, and it may be one of the leading 
symptoms for the selection of the remedy. 

Apis, sopor with piercing shrieks; meningitis. 

Bellad., heavy sleep with frequent starting, or snoring, scream- 
ing or singing; with eyes half open; always attended with fever; 
skin may be dry, but is mostly perspiring; face may be flushed, 
but is often pale. Many febrile diseases. 

Bryon., drowsy sleep with starting and crying; with chewing 
and swallowing. Head hot; children cry when taken up or 
being moved. Meningeal irritation. 

Chamom., starting, moaning, screaming, talking, weeping dur- 
ing sleep; mouth open; face occasionally distorted by convulsive 
motions; head perspires a great deal. Dentition. 

Laches., great drowsiness attending many complaints; feels bad 



MENINGITIS — INSOMNIA. 57 

or worse after sleep; starts when at the point of falling asleep 
and moans during sleep. 

Lycop., very sleepy during day with unsuccessful yawning; 
starting and jerking of the limbs during sleep; sudden loud 
screams during sleep; waking with a peevish mood, scolding, 
screaming, ugly demeanor, nervous irritation. Fevers. 

Nux mosch., unconquerable drowsiness; falls asleep whenever- 
sitting down to rest. Long spells of somnolence. Tongue often 
dry without any thirst. In company with many complaints. 

Opium, stupor; snoring; eyes half closed ; mouth open. 

Phosph. ac, being roused, answers correctly but goes to sleep 
again at once; typhoid. 

Pulsai, very sleepy with various symptoms of head, stomach 
and bowels. 

Rhus tox., drowsy sleep with murmuring and talking; typhoid. 

Insomnia. 

Aeon., fever-heat, dry skin; tossing about; lamenting; great 
pain with inflammatory processes in teeth, chest, bowels, during 
menstrual period; after fright, fever. 

Bellad., drowsy and yet unable to sleep; anguish; visions; large 
pupils ; congestion towards the head ; after morphium. 

China, ideas crowd upon the mind; after loss of blood and 
weakening diseases. 

Coffea, nervous excitement; wide awake; not the slightest in- 
clination to sleep; after great mental strain, joy, night- watching, 
acute diseases; dental irritation. 

Hyosc, drowsy or sleepless; wild expression; delirious; after 
chloroform. 

Ignat, after grief and depressing emotions; after overstraining 
the mind by racking business. 

Moschus, hysterical sleeplessness; after chloral. 

Nux vom., after mental strain till late at night; abuse of coffee, 
wine, liquor, opium, tobacco. 

Opium, excessive wakefulness, or drowsiness with inability to 
go to sleep. 

Pulsai, indigestion; after quinine, ferrum and strychnine, tea, 
chloral. 

Sulphur, very important with mfcajLJ^ different symptoms; 
sleepy in daytime; sleepless at night. 



58 BRAIN. 

These are the main remedies, of which one or the other may 
be indicated when drowsiness or sleeplessness is one of the lead- 
ing symptoms of the case. However, there are a number of cases 
where these symptoms, although prominent and distressing, may 
entirely lose their rank as guiding symptoms, and none of them 
indeed would prove satisfactory. Then we have to choose our 
remedy irrespectively of these symptoms, which will disappear 
as soon as the main string is touched. For such cases, of course, 
special therapeutic hints cannot be given a priori. 

Meningitis tuberculosa, Hydrocephalus acutus, 

Is in its nature an inflammatory affection of the pia mater, de- 
pendent upon the development of miliary tubercles. In this it 
differs from all other meningeal affections. 

The miliary granulations are always found in the immediate 
neighborhood of vessels, sometimes especially of those at the con- 
vexity, sometimes of those at the base; frequently at the arteries 
given off from the circle of Willis; they maybe spread over large 
surfaces, or they may be confined to only particular portions of 
the pia. Their number likewise varies as their distribution, and 
so do their stages of development; they grow in crops. The pia 
shows frequently, especially at the base, yellowish cloudy patches 
along the vessels and swelling of its tissues ; the ventricles are 
dilated and contain hydrocephalic effusion. The quantity of 
this effusion however varies greatly, and in many cases is entirely 
absent. The brain in some cases shows white softening, either 
of only a portion of the fornix and the corpus callosum, or of 
larger portions of its tissue lying upwards and contiguous to 
these parts. In other cases this softening is entirely wanting. 
The cortex and neighboring white substance is in many cases 
anaemic and of a dry condition, most probably a result from the 
pressure of the hydrocephalic effusion within the ventricles. 
Miliary tubercles are found almost in all other organs of the 
body. It seems then, that scrofulosis as the main spring of 
tuberculosis, is also the main cause of this disease. May it be 
latent or apparently it always has a tendency to bring inflamma- 
tory exudations to a cheesy degeneration, and when present, irri- 
tation of almost any kind: whooping-cough, pneumonia, measles. 
and other eruptive diseases, or bronchial or intestinal catarrhs, 
dentition, colds, traumatic lesions of the' bones, or periosteum of 



MENINGITIS. 59 

the joints, suppressed eruptions of the head, may lead to that 
same end. 

The sex attacked most frequently is that of the males; the age 
that between one and six years; from seven to ten years we find 
it less often, still less from ten to sixteen, and rarely afterwards. 

The Symptoms may develop slowly or rapidly. It seems that a 
crop of tubercles may be endured without causing marked dis- 
turbances; it is only when by some exciting cause an irritation is 
set up that the disease develops. The commencement may 
manifest itself in a mere indisposition, a change of mood, with 
frequent short naps full of dreams and starting; loss of appetite; 
irregularities of the bowels; febrile conditions towards evening, 
headache and giddiness. This undefined state may last a week 
and longer. Where there is already a developed pulmonary 
tuberculosis, the superadded meningitis may not be suspected 
until suddenly facial paralysis, loss of consciousness and vomit- 
ing set in. 

As the inflammation progresses, we find headache; vertigo; 
great sensitiveness to light and noise; vomiting of anything 
taken, or especially when being moved; coming at intervals and 
disappearing after some time; constipation usually, but diarrhoea 
sometimes to the end. If partial or general convulsions set in, 
we have: tremor of the eyeballs; squinting; distortions of 
the face; stiffness of the muscles of the nape of the neck and 
back; retraction of the abdominal muscles, so that the belly 
looks like a tray or boat. There may also be paralysis of the 
face; paralysis of the eyelids; one pupil may be larger than the 
other. The fever rises with evening exacerbations up to 102.2° 
or 103° F. The skin is in some cases easily reddened by slight 
pressure or scratching. And as the internal pressure in conse- 
quence of exudation increases, the mind becomes clouded ; the 
patient is drowsy, even comatose. We occasionally hear a pecu- 
liar piercing shriek which, if heard once, is scarcely ever for- 
gotten. Convulsive movements become more frequent, such as 
distortions of the face ; squinting ; chewing ; winking the lids ; 
grinding of the teeth. Paralysis of the one or the other ex- 
tremity also sets in, while the other may still keep up convul- 
sive motions; there maybe paraplegia; there maybe paralysis 
of the tongue and deglutory muscles. The pulse at this stage 
falls down to sixty and lower, but is easily excited to a hundred 
and over by any exertion ; the temperature remains the same or 



60 BRAIN. 

sinks to about 100° F., although the pulse may have risen from 
any exertion to 120 or 140. Now the fontanel in children com- 
mences to bulge ; the coma increases ; convulsions and paralysis 
continues ; the pulse rises again to 120 or 140 ; the respiration is 
irregular; sometimes the breathing seems to cease altogether, 
followed by a deep, long, sighing respiration. The face fre- 
quently changes color, now pale, and again red, and sometimes 
one side is pale and the other red. Or red spots appear on the 
face, coming and going. The blood-vessels of the eyes become 
injected, especially those of the inner canthi. This condition of 
things may last several days. When, however, the skin gets 
dripping with perspiration ; when the abdomen becomes bloated ; 
when stool and urine pass off involuntarily ; when the anterior 
fontanelle suddenly sinks in, and we hear the ominous rattling 
in the chest, then the scene will be closed within a few hours. 

The Prognosis is bad. Is the disease always fatal? Because 
there are no infallible means to distinguish during life between 
it and simple meningitis, those cases which have recovered and 
were claimed to be tubercular meningitis are simply set down as 
errors in the diagnosis; the real proof — post-mortem — is wanting, 
and therefore, as all cases which came under the hands of these 
physicians, the post-mortem proved their diagnosis correct, they 
concluded that all the other cases must likewise be fatal. Against 
this conclusion I allow myself modestly to protest. Might not a 
different treatment prevent post-mortem examinations? And 
are all tubercular affections necessarily fatal? I have lost cases 
of tubercular meningitis, to be sure, but I do believe that I also 
as well as others have cured some of them. The prognosis is 
bad, that is true. I shall defer therapeutic hints until I have 
spoken of other forms of meningitis. 

Leptomeningitis Infantum; Hydrocephalus Acutus sine 
Tuberculis; Simple Meningitis. 

Like tubercular meningitis this affection is considered an in- 
flammatory process of the pia, although on post-mortem no in- 
flammatory signs, not even traces of arterial hyperemia are 
found. The pia is unchanged ; it contains a moderate quantity 
of blood or is anaemic. The cortex and white substance are 
compressed, dry and firm; the ventricles are usually dilated 
symmetrically from hydrocephalic effusion; the softening of the 



MENINGITIS. 



61 



surrounding brain-tissue is less extensive than in tubercular 
meningitis. Only the plexus chorioidei shows signs of greater 
hyperemia than the superficial portions of the pia. No exuda- 
tion at the base. The question then, as to its inflammatory or 
hypereemic nature, cannot be answered by anatomical evidence 
post-mortem. 

As exciting causes the following are mentioned : dentition ; 
eruptive fevers; acute pulmonaiy affections; concussions of the 
brain. The disease belongs decidedly to the age of childhood, 
from one to five years. 

Its Symptoms correspond so closely to those of tubercular 
meningitis, that there is none to enable us to distinguish posi- 
tively between the two, unless we take the general outspoken 
tendency to scrofula, if it is outspoken, or the hereditary disposi- 
tion in that direction as a basis for our judgment. In many 
cases, of course, the symptoms vary, but the general type remains 
the same. Usually there are less premonitory warnings; some- 
times the inability to swallow sets in at an early stage ; the skin 
of the body is dry, while the head often perspires profusely; 
facial paralysis and paralysis of the extremities are less frequent 
than in tubercular meningitis, yet they do occur. For further 
particulars compare the foregoing. 

The Prognosis is less fatal than that of tubercular meningitis. 

Simple Meningitis of the Base. 

Without tuberculous infiltration this inflammatory process 
causes in some cases the formation of dense, hard stripes of con- 
nective tissue, or in other more acute cases, a fibro-purulent 
infiltration in the tissue of the pia at the base of the brain ; where 
hydrocephalus is present it is generally very severe. There is 
nothing known of predisposing causes; the victims are strong 
persons, between sixteen and thirty years of age; its duration is 
from seventeen to sixty -four days. 

Symptoms. — Usually commencing with a chill or chilliness, 
which is followed by heat, sweat, thirst, entire loss of appetite 
and total unfitness for work, its main and most distressing 
symptom is a persistent headache, all over the head; at times 
more especially in the occiput. The fever-heat is paroxysmal, 
the temperature rising in an irregular manner to 104° F. and 
above, to fall down again in the morning or forenoon with a 
sudden leap to the normal point. 



62 BRAIN. 

In other cases the fever continues throughout the disease, 
while in others still, the temperature shows periods of remark- 
able low even subnormal grades. There is a similar irregularity 
in the march of all other symptoms. Periods of entire conscious- 
ness alternate with mild or wild delirious attacks; one paralysis 
may disappear or give way to another; contractions and spasms 
may disappear for hours and then reappear again; altogether 
the motor symptoms make their appearance only at a very ad- 
vanced period; and in some cases they are entirely absent. 
Death follows during coma. 

These peculiarities distinguish simple basal meningitis almost 
from any other disease. Its sudden beginning in healthy indi- 
viduals in the prime of life without any tuberculous antecedents ; 
its long duration without any marked changes except those 
stated above; the late occurrence of paralyses; the rareness of 
spasmodic symptoms; the persistent headache — all taken together 
make a peculiar type. Typhoid has a different record of tem- 
perature and almost always enlargement of the spleen ; cerebro- 
spinal meningitis is an epidemic disease and besides has no such 
long-continued clearness of the sensorium ; abscess of the brain 
grows only upon abnormal conditions of the body (purulent and 
ichorous processes, affections of the bones, purulent affections of 
the lungs), and has no such characteristic march throughout. 
Tubercular meningitis may sometimes have a similar protracted 
course; but here the tubercular diathesis decides. 

The Prognosis is not favorable, but cured cases are recorded. 

There are still other forms of meningitis, which I shall briefly 
mention. 

Meningitis of the Convexity 

May come on spontaneously, that is without any bwira cause, or 
may be due to inflammatory processes in neighboring tissues, 
such as inflammation of the skull bones, caries of the inner ear, 
puriform softening of a thrombus in the sinus, panophthalmitis, 
erysipelas capitis, carbuncles of face and neck, old intra-cerebral 
affections. 

Metastic Meningitis 

Must be considered as a terminal complication of some acute dis- 
ease, of some suppurative processes at a distance. Such are 



MENINGITIS. 



G3 



croupous pneumonia with fungoid vegetations; cheesy deposits 
in the lungs; ulcerative endocarditis; pyaemia; acute rheuma- 
tism; dysentery; diphtheritis; measles; scarlatina; typhoid fever; 
Bright's disease. 

Traumatic Meningitis 

Is due either to concussion of the brain or an injury of only the 
soft parts of the skull, or a perforating injury, or a necrosis of the 
skull bones after such injury, or the breaking of an abscess of the 
brain. 

THERAPEUTIC HINTS.— As a general rule the pregnant woman 
ought to be under the watchful eye of her physician during that 
whole period. She may be relieved just during that time of 
many chronic troubles, better than at any other time and her 
offspring saved of as many serious afflictions. But where a 
mother has lost already one or more children from hydro- 
cephalus, Grauvogl's advice to administer to such a mother dur- 
ing another pregnancy Sulphur and Calc. phosph. at suitable inter- 
vals, ought never to be forgotten. Even after the birth of a child 
with suspicious hereditary proclivities, we may be able to ward off 
an acute outbreak of meningeal inflammation by one or the other 
of the following remedies: 

Baryta carb., children who do not grow, but pine away, with 
swelling of glandular structures. 

Calc. carb., fat babies with large heads, wide open fontanels, 
which are often covered with dirty or scurfy skin; fair com- 
plexion; they are lively, precocious; their head sweats profusely 
during sleep, especially on the occiput; stomach and bowels are 
large, sensitive to pressure; bowels inclined to be loose; feet damp 
and cool ; dentition slow and troublesome. 

Calc. phosph., flabby, shrunken, emaciated children; skull thin 
and soft, with fontanels wide open ; will not stand any more ; 
do not learn to walk; want to nurse all the time; great desire for 
salt meats and potatoes; after eating and drinking, bellyache; 
retarded dentition with cold tumors, emaciation and loose, green 
and at times slimy stools. 

Lycop., children sleep apparently soundly, but scream out sud- 
denly in sleep, stare about and cannot easily be pacified. 

Silic., rickety children ; sweat much about the head, especially 



64 BRAIN. 

forehead and face; claw their mouth during dentition; are prone 
to abscesses, glandular swellings and a fetid sweat of the feet. 

Sulphur, children who do not like to be washed; have pimples, 
boils and other eruptions on head, face and everywhere; pick at 
nose; have red lips; crave sour things; feel faint in the forenoon; 
may have diarrhoea early in the morning; sleep restless; start 
when falling asleep; cry out during sleep; or murmur, moan and 
whine, or snore; their feet are cold in the morning and hot in 
the evening; they run about, but do not like to stand; sit 
hunched and walk stooping. 

Thuja, children of sycotic and syphilitic taint; they are rather 
thin than fat, are prone to eruptions which, on healing, leave 
purple spots; their teeth soon turn black and decay at the gums; 
the salivary glands swell ; there is sometimes thrush or ranula; 
offensive discharge from the ears-; soreness of penis or vulva and 
about the buttocks; frequently recurring morning diarrhoea; 
pain in the left iliac region; fetid foot-sweats; often the uncov- 
ered parts sweat, while the covered parts are dry and hot. Their 
parents, one or both, have a greasy skin, and warts and moles, 
and crave salt, and the little one will by and by show these he- 
reditary symptoms. — (T. P. Scales.) 

When the real meningeal inflammation has set in, Ave shall 
have to choose between the following remedies: 

Aeon., in the first state of irritation and in the traumatic form, 
especially where there is fever-heat, dryness of the skin, restless- 
ness and impatience. The pulse is full and bounding or thready; 
the breath is short. 

Apis, convulsions; eyes, ears and skin lose their sensitiveness; 
when water is put into the mouth, there is no effort at swallow- 
ing; sopor, interrupted by piercing shrieks; bending back and 
rolling of the head; muscles of neck tense; profuse, sticky sweat 
on the head, of a musk-like odor; inability to hold up the head; 
eyes sunken, half shut; on opening eyelids no reaction; squint- 
ing; dilated pupils ; hearing gone; occasional red streaks or crim- 
son spots on the face or different parts of the body; face pale, of 
a milky blue ; grating of teeth ; scanty, but frequent emissions 
of a dark and sometimes of a milky urine, or suppression of urine; 
no stool, or thin, scanty stool, passed but seldom and uncon- 
sciously; trembling of the limbs; twitching or moving of the 
limbs of one side and paralysis of the other; irregular, slow pulse, 
or very quick and weak. 



MENINGITIS. G5 

Apoc. cami., sutures opened; forehead projecting; sight of one 
eye totally lost, the other slightly sensihle; stupor; constant in- 
voluntary motion of one leg and arm; urine suppressed. 

Arg. nitr., according to Grauvogl in the last stage. He gives 
it in the Gth dilution every two hours, and at the same time Calc. 
phosph., 2d trit., night and morning. 

Arnica, after a fall causing either concussion, a bruise or a per- 
forating wound ; also where there is suppuration in consequence. 
There are cases where the meningeal irritation does not show 
until several weeks after the injury. For such cases Arnica is 
specific. 

Art. vulg., convulsions of right and paralysis of left side; body 
cold all over; sopor, and yet drinking and swallowing water 
eagerly; face pale and oldish looking; involuntary stools, green- 
ish and thin. 

Bellad., vertigo on sitting up, with nausea or vomiting ; redness 
and heat of the face, or alternate redness and paleness; sparkling, 
shining eyes, with dilated pupils ; rolling and squinting of the 
eyes; blindness; throbbing of the carotid arteries; drowsiness, 
yet inability to sleep; or drowsy, restless sleep, with frequent 
startings; trembling hastiness in taking hold of things and sit- 
ting up; spasms affecting eyes and face, or spasms of one side 
and paralysis of the other; involuntary discharge of urine. Dur- 
ing dentition ; after taking cold by exposure to a cold north wind. 

Bryon., leaning head against something; putting hand to the 
head; uncertain, tottering gait; tired; sudden change of disposi- 
tion; dizziness; fall often and strike against things; sudden 
change of color in the face; loss of appetite; restless sleep — as 
premonitory signs. Later : head bent backwards ; verj" dark red 
face, " crimson red ; " dry lips ; dry, brownish tongue ; hasty, im- 
petuous drinking and swallowing; constipation; suppressed or 
painful urination with much straining; dry heat all over and 
especially of the head; drowsy sleep; chewing and swallowing 
during sleep ; cries when being taken up or moved. 

Canthar. may be a rival to Apis. Is important in inflamma- 
tions of serous membranes, why not in meningitis ? There are a 
number of symptoms which hint to it. Compare Condensed 
Materia Medica. 

Cilia, either real or simulating meningitis with so-called worm 
symptoms. 

Cicuta, rolling of the head from side to side, or boring of the 
5 



66 BRAIN. 

occiput into the cushions; head hot; eyes closed; on lifting the 
lids, eyes stare upwards; great agitation; child grasps at one's 
clothing in a frightened manner; jerking of limbs; convulsions 
with screaming afterwards. 

Cuprum, hot head; deep sopor with twitching and jerking of 
the limbs ; coldness of the hands, and a bluish appearance of the 
fingers. "During scarlet fever without eruption; afraid of and 
shrinking away from every one who approaches him; afraid of 
falling; clinging tightly to the nurse; won't stay in bed but in 
the lap; conscious, knows people." Tongue darting forth and 
back with great rapidity, like a snake's. After catarrhal or ex- 
anthematic fevers; during difficult dentition. 

Digit, sopor; unconsciousness; pupils dilated, insensible to 
light; blindness; one-half of face convulsed; pulse very slow, 
often hard, with a corresponding powerful stroke of the heart, 
sometimes intermittent and small ; breathing heavy, slow and 
deep ; sleep with frequent startings, and dreams of falling ; gen- 
eral convulsions. 

Gelsem., the child wants to be let alone, wants to lie still ; head 
hot, hands and feet cool; face red; eyes dull; tongue coated 
yellowish white; no thirst; breath hot, sometimes offensive: 
sleepy and drowsy, sometimes comatose; during sleep, convulsive 
motions; creeps and flushes run up the back; more or less moist- 
ure of the skin, especially on palms of hands and in the axilla- 
pulse depressed at first, later frequent and soft. During summer 
or warm weather with southerly or southeasterly wind. 

Grlonoin., headache; every pulse is felt, as if the head should 
burst ; stupefaction ; sunken eyes ; under the eyes a bluish pallor ; 
red eyes with photophobia; optical illusions; lightening; black 
spots before the eyes; blindness; in the ears pain, fulness, 
pulsation, ringing, deafness ; face is pale in spite of high fever, 
or red and hot ; temporal arteries pulsate violently ; heart beats 
strong and laborious ; pulse mostly accelerated, often changing 
suddenly to slow and back again; nausea, vomiting with the 
headache ; sudden spasms. 

Gratiola, has been given as extract with good result in a case 
where there was low respiration; occasional sighing; gnashing 
of teeth; eyes shut; pupils enlarged; slow pulse; unconscious 
discharge of fseces and urine. 

Helleb., great irritability, getting angry easily; vertigo as if 
drunk; eyes staring or rolled up, lids half closed: squinting: 



MENINGITIS. G7 

forehead drawn in folds and covered with cold perspiration; face 
pale and puffy; frequent rubbing of the nose; nostrils dry and 
dirty; chewing motions with the mouth; greedily swallows cold 
water; wants food occasionally but rejects it when offered; rolls 
the tongue from side to side; lower jaw sinks; vomits green 
mucus ; passes dark urine with a sediment like coffee-grounds. 
Breathing sometimes quick, sometimes slow and deep; sighing; 
boring back of the head; soporous sleep with screaming and 
starting; automatic motions of one arm and one leg; convulsive 
movements of muscles and jerking; exudation. 

Kali liydr., is the remedy of Kafka, for scrofulous and tubercu- 
lous subjects. The disease develops gradually, and this remedy 
ought to be given at an early stage, although even later with 
symptoms of exudation it has been found to act favorably. 

Laches., is often indicated after Lycop., especially when there is 
difficulty of swallowing; gagging with throwing up of wind; hot 
abdomen. 

Lycop., is one of the most important remedies in tubercular 
meningitis. Generally speaking it corresponds to scrofulosis and 
tuberculosis, cheesy degeneration and dropsical effusion. Special 
indications: drowsiness, loud screams during sleep; sleep with 
half open eyes, throwing the head from side to side with moan- 
ing; bad humor after sleep; comatose state; great emaciation; 
pale face; flushes of heat in the face; spasmodic twitching of the 
face ; stiffness of the neck ; constipation. Also in complications 
with eruptive fevers and pneumonia. 

Merc, sol, drowsy, sleepiness with restless throwing about and 
occasional waking with a shrill cry which is followed again by 
dozing off. The sensitiveness of the eyes to light is diminished ; 
squinting. Mercury is considered as being capable of exciting 
the process of absorption. 

Opium, soporous condition with half open eyes; snoring; iris 
insensible to light; congested face; suppressed urine. 

Spongia, according to Hering, of great importance on account 
of its relationship to scrofulosis and tuberculosis. Guiding symp- 
toms: congestion of blood to the head with pressing, knocking 
and pulsating in the forehead; redness of face with anxious mien; 
better when lying in a horizontal position; heat in the head; 
bending the head backwards with tension in the neck. Eyes 
staring, lids wide open; double sight; face pale and cold with 
the heat; alternately red and pale. Twitching of the muscles 



68 BEAIN. 

with the fever; frequent waking with a start; tossing about; 
stupid slumber. 

Stramon., head is thrust forward instead of back; conjunctiva 
injected ; pupils contracted ; desire for light, or bright light and 
glistening things cause spasms; calls for his parents Avho are 
present but does not know them ; violent delirium ; stammering ; 
great dryness of the mouth ; dysphagia ; urine suppressed ; 
trembling and convulsive movements of the limbs ; striking with 
hands and feet ; frequent torsions of the trunk ; screaming ; sup- 
pressed miliary eruptions. 

Sulphur, heaviness of the head ; it sinks backwards ; sweat on 
head of musk-like smell ; frequent change of color in the face ; 
j>ale, distorted features; sour smell from the mouth ; turbid urine 
with red sediment ; suppressed eruption on head, behind the ears 
or elsewhere. Often indicated after Bryon. or Helleb. See above. 

Zincum, cross and crabby in the afternoon and morning ; pain 
in forehead, better when lying ; sensitive to light ; dry nose ; pale 
waxy face ; relaxed features ; gagging and vomiting and yet a 
voracious appetite ; stool retarded, omitting for days ; scanty, 
turbid urine, as if mixed with clay ; cannot keep the feet still. 
Heat and fever morning, evening and part of night; restless 
sleep before midnight, after midnight more quiet, and in the 
morning awakes brightly. Complication with scarlatina. 

Hydrocephalus Chronicus 

Develops itself, in grown persons, of acute attacks of different 
forms of meningitis, which may have been brought on by ir- 
ritations of the brain from exposure to heat or cold; external 
injuries; the abuse of intoxicating drinks, or too great mental 
exertion. In children, even if it originates after birth, it is never- 
theless identical with the affection called 



Hydrocephalus Congenitus, 

that form which children are born with. It is probably the con- 
sequence of an inflammatory process of the lining of the ventri- 
cles during foetal life; perhaps it is a deficiency in the proper as- 
similation of calcareous substances which form the bones. Why 
it is, we do not know in either case. Some Avomen have given 
birth to hydrocephalic children several times in succession, 
without any apparent cause. 



HYDROCEPHALUS CHRONICUS AND CONGENITUS. 69 

As the water collects in the ventricles while the sutures of the 
bones have not yet united, its constantly increasing bulk drives 
the bones asunder and enlarges the head to an enormous size. 
Or, if we take the other view, which is perhaps the more plausi- 
ble of the two, we might explain it in this manner: The insuffi- 
ciently-developed bones are not capable of restricting the grow- 
ing brain within its proper limits ; they give way here and there, 
and the brain gains entirely too much space within the skull. 
As, however, a vacuum can never exist, it is at once filled up 
with the general equalizing medium, water or serum. In this way 
the inner pressure becomes still stronger, and the still deficient 
bony structure becomes still less capable of restraining the in- 
creased internal pressure; it gives way again and again; and for 
the same reason the effusion of water must increase still more, 
until at length the whole cranium attains to an enormous size. 

The disease can be recognized at once, although it may not 
have come to its full development. There is a disproportion 
between the size of the skull and that of the face; the fontanels 
are much wider than usual, and the frontal opening may be 
traced down into the frontal bone; and laterally, down between 
the parietal and frontal bones. The bones themselves feel thin 
under pressure of the fingers; and externally the veins appear 
greatly enlarged, shining through the skin. 

All these external changes appear only when the collection of 
water is very considerable. There have been found from six to 
ten pounds of serum within the ventricles, which then appear 
enormously distended and thickened, while the substance of the 
brain in the neighborhood is wasting away. A small amount of 
serum does of course not change the external form of the cra- 
nium ; neither is it changed should the effusion take place at a 
later period, when the sutures of the skull bones have closed ; to 
this there are a very few recorded exceptions. 

Children born with hydrocephalus fully developed, die fre- 
quently during birth or soon afterwards. Others show no signs 
of this malady in the first weeks; even during the whole of 
the first year it may be overlooked, until the inability of the 
child to hold up its head calls attention to it. But even then 
there may be no enlargement of the head visible, yet the child 
is slow in all its mental developments; it does not make any 
attempt to talk or walk ; it remains uncleanly, and its actions 
look strangely; when in joy or fear it makes antics and straggles 



70 BRA.IN. 

with its extremities. Its eyes do not look knowingly at any ob- 
ject; it shows no interest for things; it appears imbecile and fool- 
ish. Saliva is constantly oozing out of the half opened mouth ; 
it eats greedily, and often is seized with spasms. 

The progress of the disease is either a steady one, going on 
from bad to worse, until at last general paralysis ends the scene ; 
or it is interrupted by stationary periods, or it remains for years 
seemingly unaltered. It is rare, however, for such patients to 
live beyond the age of puberty ; a few only have been observed 
to live to the age of twenty. 

THERAPEUTIC HINTS.— The most important remedies for this 
affection are: Arsen., Calc. carb. and phosph., Helleb. and 
Sulphur. 

The old school confesses that' by diuretica, drastica, iodine- 
preparations and calomel nothing has been achieved ; neither 
has the compression of the skull by adhesive strips, nor a re- 
peated punction or tapping, been of use. 

Hydrocephalus Senilis 

Is that form of hydrocephalus which is found in old age, the 
second childhood of man. It seems to be developed from the 
following condition of things: The brain in old age is apt to 
shrink, which necessarily would cause an empty space within 
the skull. As no vacuum can exist, the would-be empty space 
is at once filled up with serum. The same takes place when, 
from some cause or other, only a portion of the brain becomes 
atrophied. The space which hereby is vacated is at once taken 
up by an exudation of fluid. Hence this sort of hydrocephalus 
is termed Hydrocephalus ex vacuo. It sometimes happens that the 
exudation of serum takes place so suddenly and so profusely as 
to cause all the symptoms of an apoplectic strike, when it is called 
Apoplexia serosa. 

In most cases it is impossible to make a differential diagnosis 
between it and Apoplexia sauguinea: neither have we any distinct 
signs by which to diagnose Hydrocephalus senilis. 

Meningitis Cerebro-Spinalis Epidemica. — Spotted Fever. 

This is an acute, diffusive inflammation of the pia of the brain 
and spinal cord, resulting in an exudation of purulent matter. 



MENINGITIS CEREBRO-SPINALIS EPIDEMICA. 71 

"It is deposited both on the convexity and at the base, especially 
along the course of great vessels, in the folds and depressions of 
the surface of the brain, in the fissure of sylvius, along the sulci, 
between the pons variolii and chiasma, and on the pons and cere- 
bellum. In rare cases the whole surface of the brain is uniformly 
covered." In the spinal cord the exudation is found "chiefly in 
the lumbar, less in the cervical region, and almost exclusively on 
the posterior surface of the cord," owing to the tendency of any 
fluid to nW to the dependent parts. "The brain substance is 
sometimes congested with punctiform hemorrhage and secondary 
development of small spots of softening; at other times, when the 
disease has been hyperacute or very long-continued, it is juicy or 
cedematous, with a smooth, level surface, and of a watery appear- 
ance on section. More rarely the substance is of a tough con- 
sistance." (Yon Ziemssen.) 

Although this disease may have prevailed at times in previous 
centuries, the first epidemic ascertained with certainty, is that in 
Geneva, from February to April, 1805. Since then many epi- 
demics have been observed and in all parts of the globe, with the 
exception of the tropical regions proper. It is an infectious dis- 
ease, but what its disease-germ consists of, is entirely unknown. 
It generally occurs during winter and spring, and especially 
when there is great moisture of the air and great variations of 
temperature. It selects not malarial regions, but rather sandy, 
dry plateaus, though malarial neighborhoods are not exempt. 
Childhood is most severely attacked, yet no age is spared. The 
disease-germ seems best to thrive where it finds a soil prepared by 
insufficient nourishment, damp, overcrowded, badly ventilated 
houses with unclean ground floors. 

Symptoms. — It most always sets in suddenly, commencing with 
a chill, followed by fever; violent headache; vomiting; extra- 
ordinary prostration of strength and great restlessness. The 
headache is unusually severe, sometimes in the front, sometimes 
in the back part of the head ; its cessation is a very favorable 
sign. Vomiting is especially excited by rising and rarely absent. 
The fever-temperature is very irregular, varying in the mean 
from 100.4° F. to 104° F., with very irregular variations above 
and below these points, often interrupted by long-continued 
normal temperatures, while the other symptoms continue un- 
abated. The pulse is likewise irregular; its frequency does not 
always correspond to the height of the temperature, and varies 



sometimes thirty to forty beats in a few hours. A slow pulse is 
less frequently found than in meningitis tuberculosa, and a con- 
tinued rapidity is unfavorable. In severe cases there occur at 
the start loss of consciousness, coma or delirium, or at least som- 
nolence, out of which the patient may be roused by being spoken 
to, answering correctly, but soon relapsing into the same state 
again. Some cases commence with convulsions, and that char- 
acteristic stiffness of the neck, which in a few hours may develop 
into a tonic contraction of all the extensors of the spinal column ; 
orthotonos is frequent; opisthotonus is rarer; rarest is pleurotho- 
tonos or the unilateral contraction of the spinal erector muscles. 
In rare instances, however, the stiffness of the neck is entirely 
absent. There is great aching in all the limbs, and especially in 
the spine, a universal oversensitiveness of the skin; every touch 
and motion causes great pain. Now appear also cutaneous erup- 
tions, herpes on the face, or on the extremities ; then erythema, 
roseola, urticaria and petechia?. The name of the spotted fever 
was suggested by those irregular, purplish ecchimosed spots from 
the size of a pin's head to larger patches, which appear generally 
on the second day of the disease upon various parts of the body, 
usually first on the upper eyelids, gradually extending to other 
parts; they do not get white under pressure. In some cases they 
are absent. From the third to the fifth day the tongue becomes 
dry and cracked, in comatose cases; in other cases it remains 
moist but heavily coated. There is sometimes diarrhoea, at other 
times constipation. In other cases the symptoms of irritation 
are followed by symptoms of depression; no reaction ensuing; 
unconsciousness is complete, stools and urine pass off involun- 
tarily, pulse and temperature rise, convulsive movements, half- 
sided paresis, general convulsions, profound coma follow each 
other and death closes the scene. In favorable cases these symp- 
toms of depression do not set in at all, or are not so marked nor 
lasting. The headache, the pains in the limbs and spine con- 
tinue, but gradually grow milder and convalescence begins in 
from one to two weeks, though sometimes later. There are cases 
especial during the commencement of an epidemic, which ter- 
minate fatally in from twelve to thirty hours; and on the other 
hand, there are cases even during the height of an epidemic, 
which are so light, as to allow the patient to continue work. 

As Sequel.e have been observed : " Deafness, derangements of 
vision, chronic hydrocephalus and chronic meningitis, with the 



MENINGITIS CEREBRO-SPINALIS EPIDEMICA. 73 

consequent impairment of intelligence, and lesions of motility in 
the form of paralysis and paresis." 

The. Diagnosis is difficult in isolated cases and when the dis- 
ease occurs in complication with other acute diseases, especially 
croupous pneumonia. It differs, however, from Tuberculous men- 
ingitis by the suddeness of its attack, the irregularity of pulse 
and temperature, and its peculiar eruptions ; from Typhoid by the 
same pecularities. In the first days a distinction between the 
two may not be possible, but a few days of observation of the 
temperature will decide. When in complication with pneu- 
monia, its diagnosis may remain doubtful for some time ; how- 
ever, the stiffness of the neck and the painfulness of the spine 
will lead us to suspect such complication. 

Its Prognosis is grave, especially in infancy and old age and in 
all cases where the symptoms are very violent and the state of 
depression continues without any apparent reaction. Each single 
case has to be weighed b} r its own peculiarities and even these 
doubtful cases may take a favorable turn, while others prove fatal 
even under careful treatment. 

THERAPEUTIC HINTS.— Aeon., chill; fever; restlessness; dry 
skin ; great thirst. Still I have not seen, nor found mentioned 
great achievements from this remedy. 

Act. rac, intense pain in the head, as though a bolt were driven 
from the neck to the vertex with every throb of the heart ; pain 
at the base of the brain and up and down the whole length of 
the spine ; stiffness of neck and back ; intense pain in the eye- 
balls ; tongue swollen, or raw and red ; redness of fauces and 
palate ; soreness and bruised feeling of the muscles generally, or 
sometimes confined to a circumscribed spot, and often changing 
location, and with a feeling as if an abscess were forming ; great 
sensitiveness of the skin. Creeping chills in the back ; profuse, 
sometimes cold perspiration all over ; tonic and clonic spasms ; 
delirium, like delirium tremens ; sees cats and dogs, etc. 

Apis, often indicated. Compare Meningitis. 

Arg. nitr., recommended by Grauvogl, is undoubtedly of great 
importance. It has tremendous headache of all kinds ; vertigo ; 
photophobia; clouds before the eyes; double vision; eyeballs 
floating in mucus ; deafness ; pale and emaciated face ; lips and 
nails blue ; white coated tongue, or dry and hard tongue, like 
bark and black; black coated teeth; cannot talk; wants to drink 



74 BRAIN. 

sweet things, sugar water, the juice of boiled, sweet prunes; stools 
and urine unconsciously; oppressed breathing; wants to be 
covered all the time and yet wants fresh air, the windows open ; 
cannot move himself. Soporous sleep, with constant murmur- 
ing; it is difficult to rouse him, and when half roused, the eyes. 
scarcely opened, fall shut again. The whole left side is weak. 
Emaciation; constant trembling of hands; jerking of single 
muscles. 

Arnica, sopor; cringes when touched anywhere, even during 
unconsciousness; great soreness all over; diuresis; during stage 
of great weakuess. 

Arsen., great restlessness and prostration ; arsenic thirst ; inter- 
mittent type. 

Bellad., often indicated by the violent headache, drowsy state, 
and delirium ; dilated pupils ; double sight. 

Bryon., bursting headache; stiffness of neck; great pain in 
joints and limbs, all worse from motion. 

Camphora, cold, deadly pale or blue, almost pulseless from first 
shock of chill without reaction. 

Cann. ind„ vertigo on rising with stunning pain in the back 
part of the head; fixed gaze: dilated pupils; sensitive to sounds; 
cold face, with drowsy and stupid look; anguish in the chest 
with great oppression; pain across shoulders and spine; paralysis 
of lower extremities and the right arm; convulsions: emprostho- 
tonus, with loss of consciousness; collapse; stupor; pale, clammy 
and insensible skin; feeble, irregular pulse. (Hale.) 

Chin. sulph., violent throbbing headache; vertigo; heat in face; 
involuntary closing of the eyelids from sheer prostration; inter- 
mittent type. 

Cicuta, insensibility ; double sight; dilated pupils: staring look: 
jerking of eyeballs, muscles of face, arms and hands: perfect deaf- 
ness; dumb for several days; ashy paleness of face; head re- 
tracted; rigid spine; dysphagia; first diarrhoea then constipa- 
tion; rapid pulse; insensibility to touch and pinching: paralysis 
all over. 

Crotal., horrid headache; delirium with open eyes: pain in all 
the limbs; ecchymosed spots everywhere; convulsions and pa- 
paralysis. 

Gelsem., feeling as of a tape around the head; great drowsiness; 
itching of head, face and neck; loss of vision and speech : nausea : 
pulse feeble; respiration labored and feeble: trembling and com- 
plete loss of muscular power; sweating relieves. 



PACHYMENINGITIS. 75 

Glonoin., violent throbbing headache with sense of expansion ; 
blindness with faintness and nausea; pale face; pain through 
the whole length of spine. 

Hyosc, delirium, muttering or wild; double sight; convulsions. 

Lycop., sopor; sinking of lower jaw; fan-like motion of nos- 
trils; feeling of tension in chest and abdomen as of a hoop; don't 
want to be alone; jerkings of limbs and body. Compare under 
Meningitis. 

Opium, stupor ; spasms ; drawing the body backwards and roll- 
ing from side to side; deep, slow breathing; very quick, or very 
slow pulse. After violent emotions, fear, grief, fright, which 
acted like a blow, stunning the whole nervous system. 

Rhus tox., stupefaction and vertigo; various eruptions, eczema 
on face; nosebleed; dry cough, perhaps bloody sputa; great ach- 
ing pains all over with restlessness. 

Ver. vir., during first stage with coldness of surface ; loss of con- 
sciousness, labored, slow and irregular pulse. Later: trembling 
as if frightened and on the verge of spasms ; convulsions ; retrac- 
tion of head; rolling of head; rolling up of eyes; opisthotonos; 
very frequent and feeble pulse. 

Protracted recovery hints to: Calc. carb., Carb. veg., Psorin., 
Silic, Sulphur, Zincum. 

Pachymeningitis, Inflammation of the Dura Mater. 

The dura consisting of a periosteal (external) and an inner 
lamella, pathology recognizes : 

1. Pachymeningitis externa, which may be caused by external 
injuries ; separating the membrane from the inner surface of the 
skull, or bruising and tearing it; or by transmission of inflam- 
mation from neighboring tissues. It always is confined to cir- 
cumscribed spots, and seldom recognizable as a separate affection, 
because of the ease with .which the inflammatory process may 
spread to the inner lamella and pia. Pachymeningitis of old 
age is frequently detected post-mortem, without any marked 
symptoms during life. 

2. Pachymeningitis interna may be a mere continuation of in- 
flammatous and suppurative processes of the outer layer. As 
such it is as little recognizable during life as the former. 

3. Pachymeningitis interna Hemorrhagica or Haematoma durae 
matris is in fact not an inflammation, but an extravasation of 



76 BRAIN. 

blood, which undergoes the usual changes of a coagulurn, and 
developing from itself a new formation. It is found either on the 
surface of both hemispheres or only on one, and principally at- 
tacks persons after 30 years of age and upwards, although cases 
under that age are likewise recorded. 

The Symptoms must naturally vary according to the quantity 
of extravasation, its location on one or both hemispheres or its 
spreading from one to the other, and its repetition. A sudden 
and increasing compression is indicated by headache, drowsiness, 
loss of consciousness, fever, slow, sometimes irregular and towards 
the end mostly very frequent pulse. The contraction of the 
pupils, the absence of strabismus and ptosis indicate that the 
convexity is the seat of the lesion; the simple rigidity, paresis or 
actual paralysis of the muscles, the disturbances of sensation 
numbness, formication, when present on one side only or on both, 
or progressing from one side to the other, indicate its location on 
the opposite hemisphere or over both, or its spreading from one to 
the other. Coma, disturbances of respiration, slowness of pulse, 
inability to swallow, cessation of reflex movements of the pupils, 
indicate a compression of the whole brain, while convulsions of 
one side and then on the other, afterwards paresis of one side with 
paresis of the facial or hypoglossus of the same side, then paresis 
of the other side show irritation of the motor centres of the sur- 
face of the brain. The intervals between different attacks of ex- 
travasation are characterized by headache, diminution of intelli- 
gence, loss of memory, drowsiness, partial paralysis, disturbance 
of speech, sudden mental excitement without cause and fre- 
quently mixed symptoms of dementia paralytica. 

Its predisposing influences are old age. atrophy of the brain 
from alcoholism, atheroma, affections of the lungs, heart and 
kidneys, chronic psychoses, anaemia perniciosa, hamiophilia, 
scorbutus. 

Its duration may extend from one day to one year and longer. 

For therapeutic Jiints see under meningitis and apoplexy. 

Encephalitis ; Abscess of the Brain ; Red and Yellow 
Softening of the Brain. 

It is a true inflammatory lesion of the cerebral substance, a red 
softening and consequent abscess of the brain. The yellow soften- 
ing is the consequence of a hemorrhagic infarction, through the 



ENCEPHALITIS. 77 

plugging up of a cerebral vessel, which may lead, however, by 
irritation, to a true encephalitis, and so may, vice versa, after 
its inflammatory stage has passed away, the true encephalitis 
assume the appearance of yellow softening and even be accom- 
panied on the surrounding cerebral tissue by a partial necrosis, 
so that indeed we may find spots of softening in the brain, of 
which we cannot ascertain the nature of the preceding process. 
True encephalitis is found always only in small spots (foci). 
These foci are red from extravasated blood and swollen; its 
boundaries imperfectly defined. By and by, if they are not ab- 
sorbed almost completely, which small ones of a traumatic nature 
certainly do in many cases, they undergo the well-known destruc- 
tive and reabsorbing changes ; we see before us a focus of yellow 
softening, which gradually becomes more colorless, is transformed 
into a cavity with a thin emulsive fluid, and may, at last, lead 
to the formation of firm sclerotic cicatrices ; or the transformation 
results in a collection of pus — an abscess. Recent abscesses have 
usually no enveloping capsule, while old ones have. As they 
grow they increase the intercranial pressure and retard the cir- 
culation in the brain, or compress the neighboring vessels in such 
a degree as to cause yellow softening of the surrounding brain- 
tissue to a large extent. The abscess may perforate the surface 
of the brain into the ventricles, or open upon the base and give 
rise to diffuse acute meningitis of the base. 

It causes widespread acute oedema and also anaemia of the 
brain, and when located in the cerebellum in such a position 
that it lessens the cavity of the fourth ventricle, or of the aquse- 
ductus Sylvii, hydrocephalus internus chronicus. 

It may discharge through the skull into the subcutaneous tis- 
sue, or into the frontal sinuses and nasal fossse, or through the 
temporal bone in the neighborhood of the processus zygomaticus, 
under the temporal muscle, or into the cavity of the tympanum. 

Abscess of the brain is either single or multiple and varies 
in size. 

The most frequent Cause of acute inflammation and recent ab- 
scess is traumatic injury; but there are also mentioned : Affections 
of the skull-bones, tumors in the brain, acute diseases, such as 
typhoid, scarlatina, affections of the heart, suppurating and 
sloughing processes in different portions of the body. These 
causes apply to the capsulated and chronic abscess. 

Its Symptoms are not at all well defined. An acute encephalitis, 



78 BRAIN. 

say from a non-perforating injury of the head, may run its course 
without our having a suspicion of its existence. Still symptoms, 
like the following, should not be unheeded : Dizziness ; head- 
ache; vomiting; loss of consciousness; sopor; pupils wide and 
fixed; pulse slow; rolling of the eyeballs ; transitory divergence; 
paralysis of the face or even hemiparesis or hemiplegia ; twitch- 
ing of both hands and feet ; convulsions of the extremities. Its 
extent cannot be determined. If not cured, it may result in cal- 
cification of ganglion-cells, situated under the injured part ; in 
chronic irritable melancholy ; in chronic headache, dizziness, 
anxiety and hallucinations ; in inability to think, with intercur- 
rent periods of excitement and illusions of the senses ; in com- 
plete imbecility , in a state resembling dementia paralytica ; in 
epilepsy and tumors. 

The Diagnosis must principally be based on the knowledge of 
its etiology. 

THERAPEUTIC HINTS may be looked after under the preceding 
chapters on the different forms of meningitis. 

Insulatio, Sunstroke, Thermic Fever. 

Whether it be, according to von Grauvogl, a want of water in 
the blood; or according to H. C. Wood, a paralysis of the vaso- 
motor nerves or some controlling centre in the brain, which in- 
fluences the production of heat in the body; or according to Hill 
in Braithivaite's Retrospect, 1S07, an imperfect decarbonization of 
the blood ; or according to Huguen, a hyperemia of the pia and 
brain; or according to Arndt, a diffuse encephalitis; or accord- 
ing to Nothnagel, a venous hypersemia, dependent upon a dimin- 
ished power of activity of the heart ; or according to R. Gregg, 
a development of gas or steam in the brain — we shall leave un- 
decided ; all physicians, however, agree that it is caused by 
the influence of excessive heat, and not merely by an exposure to 
the direct raj's of the sun. The results of post-mortems are 
meagre; the most important may be gleaned from Dr. H. C. 
Wood's, Jr., Thermic Fever, 1S72, in which he states: "Right 
heart and pulmonary arteries, with their branches, gorged with 
dark fluid blood; venous congestion of the lungs and entire 
body. The heart, especially left ventricle, rigidly contracted in 
every case, caused by a coagulation of the myosin, is pathognomic 



INSULATIO. 79 

of sunstroke. In most cases, however, it is a post-mortem rather 
than an ante-mortem phenomenon. The muscles after death 
from heatstroke soon become rigid, sometimes instantaneously 
so." As Predisposing Causes are enumerated : " Want of accli- 
matization, lengthened exertions, deprivation of water, the free 
and habitual use of vile drinks, debilit} r , a febrile state, fatigue, 
bad ventilation, improper head covering and clothing, depressing 
influences." 

Symptoms. — The final " stroke " does not at all set in without 
warnings. At first the wonted work becomes a burden; the 
muscles lose their elasticity ; there is great debility, loss of ap- 
petite, but great thirst. The head grows dizzy, achy; the chest 
feels oppressed, with frequent and short breathing and sighing; 
the throat gets dry, and swallowing painful ; the voice becomes 
weak and hoarse ; there is a general anxiety and irritableness of 
the mind ; numb feeling in the extremities ; restless sleep, or 
great drowsiness ; increased vertigo, perhaps nosebleed, redness 
of the conjunctiva, pale face, tottering gait, or giving way of the 
knees. Many complain of a dreadful goneness at the pit of the 
stomach, nausea, vomiting ; pain in the bowels, perhaps sudden 
diarrhoea, with profuse cold perspiration. Oftener the bowels re- 
main constipated. The mind becomes clouded, he answers con- 
fusedly. If for such and similar indications nothing is done in the 
vain hope that it be a mere transient indisposition, the " stroke " 
will surely and speadily follow, unless a change in the tempera- 
ture should heed it off by a still more rapid turn. This last link 
of a whole chain of more or less pronounced symptoms is very 
appropriately called " stroke." As if felled down by a blow, the 
patient sinks suddenly to the ground, with entire loss of con- 
sciousness, and complete insensibility of longer or shorter dura- 
tion ; subsultus tendinum ; partial spasms, or violent general 
convulsions ; or paralysis of the spinal cord, so that he cannot 
move a limb. The face at first is very pale, gradually growing 
flushed, suffused, often deeply cyanosed, and finally assuming a 
leaden hue. The breathing is slow and sighing, or rapid; or 
deep and labored, often stertorous, with rattling in the trachea. 
The pulse grows feeble and exceedingly rapid ; later irregular, 
intermittent and thready. 

Such a "stroke" might be mistaken for apoplexy, if it were not 
for the heat of the season and the premonitory symptoms. Apo- 
plexy may occur at any season and is often preceded by apparent 
good health. 



80 BRAIX. 

Sunstroke is not necessarily fatal and least under homoeopathic 
treatment ; however, it occasionally leaves very unpleasant after- 
effects, which " consist principally in symptoms of deranged inner- 
vation, inability to endure heat and sunshine, insomnia, vertigo 
and weakness, headache which returns after exposing oneself to 
the rays of the sun, or comes at regular times and in various 
parts of the head; chronic encephalitis; insanity; constipation; 
dyspepsia and derangement of the liver." 

THERAPEUTIC HINTS.— Man will never be satisfied. Cold 
water he improves by ice. Now-a-days it would be very old- 
fashioned not to keep ice-water summer and winter, and to gulp 
it down during, after and between meals. So dictates fashion, 
and it is good for the doctors and ice-companies. So in the 
treatment of sunstroke. Plain water, as well or river provide it, 
is entirely out of date. Being a " stroke," it must be dealt with 
"strikingly." Ice-water and ice-bags are the order of the day. 
Do we cure a frozen limb by boiling it? Will you cure a 
man, nearly boiling, by freezing him? Where is the sense? 
But fashion has none. When you are called to treat a man 
struck down by the sweltering heat, take water as river or well 
present it, and bathe his face, head, chest and spine, arms and 
limbs well with it. If you can have it lukewarm, it is better, 
because it is nearer to his temperature and by evaporation will 
withdraw sufficient heat, to cool the body down to a natural 
temperature in a very short time, without shock or malice. This 
alone may restore conciousness in a short time. But Ave have 
also remedial agents which may prevent the stroke, or shorten 
its attacks and prevent bad consequences. 

Among the remedies of prevention 

Gelsem. is the most important It covers all the symptoms of 
a man who feels " play'd out," as Lilienthal so characteristically 
designates it. It is especially indicated in hot, damp, stifling 
weather, the exact meteorological condition of sunstroke and it 
has, at least in my practice, proved itself adequate to the occasion. 

Aeon, and Arsen., are characterized by great thirst, hot and dry 
skin. 

Ant. crud., by a white tongue, loss of appetite. 

Bryon., by great thirst, gastric derangements and aversion to 
motion. 

Carb. veg., vertigo ; heaviness of head ; pulsative pain above 
eyes ; general debility ; obtuseness of sensibility. 



IXSULATIO — APOPLEXIA SANGUINEA. 81 

Laches., by great dryness of throat, hoarseness; tightness and 
oppression of chest, and drowsiness. 

Ver. vir., by prostration, febrile motion and accelerated pulse. 

Among the remedies during the attack 

Grlonoin is the most important. Violent headache ; vertigo ; does, 
not know the street nor his own house ; losing senses and sink- 
ing down unconcious. Conjunctiva reddened; mist, black spots 
or visions of light before the eyes ; pale and agitated countenance. 
"White tongue as if painted. Thirst, pain and throbbing in the 
pit of stomach with a sense of sinking. Oppressed breathing, 
sighing, constriction and anxiety. Laborious and violent action 
of the heart. Numbness of limbs ; muscular tremor ; great pros- 
tration ; sopor ; convulsions. 

Aniyl nitr., anxiety; longing for fresh air; dull confusion of 
head; giddy, intoxicated feeling; head feels full to bursting; 
eyes protruded, staring; conjunctiva bloodshot; intense surging 
of blood to the face ; crampy , epigastric pain ; burning and press- 
ure in stomach ; dyspnoea and constriction of chest and heart ; 
tumultuous beating of heart; tremulousness of hands and tired 
feeling in legs; tottering gait; weak, relaxed feeling. 

Bellad., similar to Glonoin. Drowsiness; dulness of mind; 
congestions towards head; loss of .consciousness; headache; ver- 
tigo; anguish; flashes before the eyes; whizzing in ears; con- 
striction of chest ; worse in summer heat. 

Camphora, sinking of the forces; oppression of breathing; em- 
barrassed action of the heart; coldness of fcody; tremors and 
cramps. 

Opium, unconsciousness; deep coma; eyes glassy and half closed. 

Sequelae may be met with by 

Agar., vertigo from sunlight. 

Anac, loss of memory. 

Baryta carb., Laches., Natr. carb., Stramon., headache from being 
exposed to the sun. 

Apoplexia Sanguinea. 

It consists of an intra-cerebral hsemorrhage, forming clots of 
various dimensions, usually from the size of a hazel-nut to that 
of a small apple, but they may be much larger or much smaller ; 
their shape is either round or they are spread out in layers to a 
greater or less extent; they may occur singly, which is the rule, 



82 BRAIN. 

or in numbers of two, four or more. Their favorite seats are the 
corpus striatum and the nucleus lenticularis, with the neighbor- 
ing parts of the hemisphere, and the thalami optici; in other 
parts they occur only exceptionally, and in the cornu Ammonis, 
the corpus callosum or the fornix scarcely ever. 

Unless fatal after a few hours, these clots and the surrounding 
tissue soon undergo structural changes. By absorption of the fluid- 
parts the whole mass thickens, turns at first dark red and later 
yellowish, and the surrounding tissue becomes soft partly from 
the inhibition of serum and partly from fatty degeneration, or 
inflames to a greater or less extent. If the patient survives the 
attack for some time, the clot forms into a cyst which may persist 
without change, or is converted into so-called apoplectic cicatri- 
cial tissue. 

Capillar;/ haemorrhages, showing blood-points of the size of a 
pin's head and smaller, arc met with in places of softening, or in 
the cortex cerebri in consequence of thrombosis of the venous 
sinuses; they are secondary processes and should not be consid- 
ered under this head. 

The Cause of these intra-cerebral haemorrhages is now in gen- 
eral attributed to a diseased condition of the cerebral vessels, espe- 
cially the arteries, which consists according to Charcot and Bou- 
chard in the formation of numerous miliary aneurisms, in conse- 
quence of chronic periarteritis. They may burst spontaneously 
under an ordinary amount of blood-pressure within the cranium, 
as in cases where the apoplectic attack occurs during sleep or in 
perfect rest, or they may be ruptured by an increased amount of 
blood-pressure during spells of hard coughing, vomiting, laugh- 
ing, straining at stool, or during parturition; in consequence of 
mental excitement, or bodily exertions; after a full meal and the 
use of alcohol and coffee and other cardiac stimulants. The most 
frequent occurrence of apoplectic attacks is after forty years of 
age, although childhood is not exempt. 

Symptoms. — In some, cases, not in all, the first attack is pre- 
ceded by premonitions for weeks, months, even years. These 
are: frequently recurring dizziness, headache, ringing in the 
ears, muscae volitantes, alterations in the disposition, sudden but 
transient loss of power to speak without paralysis of the tongue: 
sudden transient paresis in one arm, or leg, or both: or a sense 
of stiffness, a feeling of "pins and needles." numb feelings, or 
sensation of heat and cold, or of pain of an indescribable character 



APOPLEXIA SANGUINEA. . 83 

in the extremities; disturbances of vision, diplopia and even 
amorosis ; sometimes nosebleed. 

The attack itself is ushered in hj a sudden loss of conscious- 
ness, in many but not in all cases. It may develop itself gradually 
with symptoms above described, and unconsciousness following- 
only after a lapse of several hours or days, especially after vene- 
section ; or it may commence with paralyis of one side ; or with 
chronic or tonic spasms of certain muscles w r hich later become 
paralyzed, when hours afterwards sopor follows; or consciousness 
may not be lost for a moment, although the symptoms which 
precede the attack and those which usually follow and remain 
permanently after the return of consciousness in the usual 
cases, leave no doubt of an actual intra-cranial haemorrhage. In 
case of complete sopor and relaxation of all the muscles in a de- 
gree that hemiplegia cannot be recognized in order to distinguish 
the attack from opium poison, asphyxia, etc., we shall find the 
eyeballs turned toward the non-paralyzed side of the body ; this 
symptom usually lasts a few days. The color of the face is not 
uniformly the same in all cases ; sometimes it is deep red, even 
cyanotic; sometimes natural, or again quite pale; the pupils 
may be dilated, of normal size or contracted; one pupil larger 
than the other points to a unilateral affection of the brain ; the 
pulse varies likewise in different cases ; in most cases it is slow 
and sometimes irregular ; in others very rapid and regular ; the 
respiration may be quiet and regular as in healthy sleep ; it may 
be labored, stertorous ; it may, during deep sopor, be a kind of 
blowing, drawing the cheeks in during inspiration and puffing 
them out during expiration — the so-called tobacco-smoker's re- 
spiration ; towards the end respiration becomes intermittent and 
irregular. The temperature is at first usually lowered to 9G.3 F., 
and remains so in the fulminating form until death. If life 
endures for from ten to twenty-four hours, the temperature rises 
rapidly. If life is prolonged to a still longer period, the temper- 
ature rises only to 99.8° or 100.4° F. where it remains ; another 
sudden rise is a very unfavorable symptom, as it usually precedes 
death. Urine and faeces pass off involuntarily during sopor. 
Fulminating cases terminate in from five minutes (rare cases) to 
three or four days. Recovery rarely takes place after the coma 
has lasted forty-eight hours. But even if the coma ceases, health 
is by far not restored ; now inflammatory reaction sets in ; the tem- 
perature rises from a few tenths of a degree to two degrees ; there 



84 BRAIX. 

is occasional cloudiness of mind, even delirium ; loss of appetite ; 
convulsive movements, even tonic contractions with pain in 
these parts. This may last for several days, and then subside for 
a time, when the same symptoms, although in a milder form, 
reappear again at intervals of two, four or eight days. But there 
remain permanent symptoms for a long time often through life 
which depend on the extent and seat of the destruction caused 
by the haemorrhage. These are, with a few exceptions, hemiplegia 
of that side of the body which is opposite to that in which the 
lesion of the brain occurred ; paraplegia if the haemorrhage oc- 
curred simultaneously in both hemispheres ; partial paralysis, for 
example, of the facial nerve, in connection with extravasation in 
the optic thalamus, and in the corpus striatum; contracture (in 
the later stages) of the paralyzed limbs ; ansesthesia of the affected 
parts, which may or may not diminish or completely disappear; 
hyperalgesia, by which a light touch is felt as pain, and which 
may alternate with ansesthesia or even exist side by side with 
it for years ; spontaneous attacks of pain in the partially or totally 
paralyzed limbs. 

There are also disturbances of the trophic and vasomotor nerves. 
The affected limbs are often hotter and redder for some time than 
those of the unaffected side ; they are swollen, oedematous ; they 
sweat profusely ; after some time, however, they become cold ; or 
the skin is tending to be dry and scaly from the first ; the pulse 
is diminished in its amplitude; bedsores appear; the nails be- 
come yellowish, ridgy, brittle and curved in both directions; 
the hair grows thicker and longer, and the skin becomes hyper- 
trophied — all on the paralyzed side. 

Of the special senses taste is limited to the forepart of the 
tongue on one side in consequence of an affection of the chorda 
tympani ; this symptom usually disappears soon, but may last 
for a long time. Hearing is sometimes slightly affected, and 
sight in the form of hemiopia frequently. 

Among the menial disturbances deficiency of memory is the 
most prominent, especially in regard to recent impressions, while 
old ones can be recalled with unimpaired distinctness. The 
power of judging may gradually weaken until the patient is re- 
duced to childishness or dementia ; the disposition often changes 
to peevishness and irritableness. 

The Prognosis is grave; even if recovery from the shock takes 
place, the consequences of the reactive inflammation are always 



APOPLEXIA SANGUINEA. 85 

to be dreaded, and there is no safety for a renewed attack at any 
time thereafter. 

THERAPEUTIC HINTS.— Remedies to prevent the attack ought 
to be studied under hypersemia, to which may be added : 

Sepia, after previous attacks; in men who have been addicted 
to drinking and sexual excesses, with a disposition to gout and 
haemorrhoids. Forerunners: dizziness in walking, with stagger- 
ing ; things fall out of their hand ; forgetfulness ; use wrong 
words when writing ; cold feet ; intermitting pulse. 

Remedies during the attack and its inflammatory stage: 

Aeon., head hot; carotids throbbing; skin hot; pulse full and 
hard, but not intermittent; after fright or vexation, or suppressed 
habitual bleedings. 

Arnica, head hot and rest of body cool; paralysis of left side; 
pulse intermittent or irregular. 

Bellad., red face; dilated pupils; loss of sight, smell and speech; 
pulsation of carotids; spasms in the face ; thick tongue, protrud- 
ing; difficult deglutition; involuntary emission of urine; reach- 
ing with the hands to the genitals; moaning; paralysis of limbs 
right or left; coma, sopor. 

Coccul., face red and hot; eyes closed, with the balls constantly 
rolling about; pupils dilated; breathing without noise; stupor; 
left or right extremities paralyzed; after night-watching and 
exhaustion. 

Gelsem. and Glonoin., see under Hypersemia. 

Hyosc, sudden falling down with a shriek ; soporous condition ; 
face red; inability to swallow; involuntary discharge of feces; 
blood-vessels swollen ; pulse quick and full ; numbness of hands 
after consciousness returns. 

Laches., left side mostly affected; blowing expiration; cannot 
bear anything to touch his neck; when conscious, talks and 
jumps abruptly from one idea to another; after the use of liquors 
or mental emotions. 

Lanroc, vertigo; bloated face; jerking of the facial muscles; 
speechless by full consciousness ; palpitation of the heart; scarcely 
perceptible pulse; cold, moist skin. 

Nux vom., snoring; paralysis of lower jaw and (mostly)' of the 
lower extremities, which are cold and without sensation; after a 
hearty dinner, or abuse of liquor or coffee. 

Opium, open eyes; dilated pupils; red face; jerking of the mus- 



86 BRAIN. 

cles of the face; sinking of the lower jaw; foam before the 
mouth ; slow, irregular or stertorous breathing ; convulsive mo- 
tions of the extremities, or tetanic stiffness of the whole body; 
cold paralyzed limbs ; hot sweat on the head. After conscious- 
ness is restored, the patient cannot retain what he reads and for- 
gets the connection of consecutive thoughts. Old drunkards: is 
followed well by Nux vom. 

Remedies for subsequent chronic changes: 

Anac, loss of memory ; general paralysis. 

Caustic, inability to select proper words; paralysis of face or ex- 
tremities, which latter is complicated with muscular contractions. 

Cuprum, paralysis of tongue, stuttering, deficient spe'ech; the 
paralyzed limbs grow thinner, but preserve sensation; frequently 
complicated with unyielding contractions or chorea-like par- 
oxysms. 

Plumbum, consciousness blunted; memory deficient; speech im- 
peded, single syllables are omitted or the syllables cannot be 
combined into words; mimic spasms of face when speaking; 
trembling of tongue when it is put out; semi-paralysis of the 
buccinator muscles and of the velum palatinum, which manifests 
itself by violent snoring ; sleeplessness, fear of death ; the organs 
of the senses are torpid and insensible, the eyes are principally 
affected; the eyelids droop as if paralyzed; the pupils most con- 
stantly dilated ; all objects seem smaller and farther removed 
from the focus of vision; they may be seen as through a gauze; 
diplopia; pulse always slow, 50 to GO in the minute; sometimes 
hard and tense like a wire; all the muscles may be paralyzed, 
especially of left side; the paralysis affects equally the motor and 
the sentient nerves, is often attended with violent pains in the 
paralyzed parts, and considerable contractions, especially of the 
extensor muscles, which feel as hard as wood: in other cases the 
spasms are tonic, which, if they reach their full development, run 
into complete epileptic convulsions; the muscles of the affected 
parts become atrophied. If the paralysis is not complete, the 
patient's gait is unsteady, with particular tendency to fall for- 
ward. The paralyzed respiratory muscles often occasion a high 
degree of dyspnoea. The sphincters are scarcely ever paralyzed. 
(Baehr). 

Zincum, senses remain disturbed after the attack. 

Besides, compare what has been said under Meningitis. 



OCCLUSION OF THE CEREBRAL ARTERIES. b< 

Occlusion of the Cerebral Arteries ; Embolism and Throm- 
bosis ; Softening of the Brain. 

An occlusion of the cerebral arteries takes place either by em- 
bolism, when the occluding mass is carried by the stream of blood 
from some other parts of the vascular system to a place where, 
on account of the smallness of the vessel, it cannot go any farther; 
or by thrombosis, when the occluding mass is produced on the 
very spot of the occlusion. 

The emboli consist either of blood clots, masses of fiberine, con- 
nective-tissue growths, or chalky concretions, the principal source 
of which is endocarditis; and next aneurism of the aorta; seldom 
thrombotic masses from within the lungs. 

Thrombosis takes its origin through structural changes in the 
vascular walls, such as fatty degeneration, or inflammation of 
the coates of the arteries, leading to sclerosis, ossification, or cal- 
cification, by which a gradual slackening in the speed of the 
blood-current takes place, until an entire stoppage ensues. 

The emboli are carried much oftener into the left carotid than 
into the right, and they only exceptionally become lodged below 
the circle of Willis, but are swept into the arteria fossa. 1 Silvii, 
which is the chief direct prolongation of the carotid. Sometimes 
several arteries become the seat of occlusion at the same time. 
If the seat of occlusion is below or on the cardiac side of the 
circle of Willis, or if the embolus is swept onward into the arte- 
rial system of the cortex, no anatomical changes follow in the 
cerebral substance, because the circulatory disturbances are 
readily compensated for by collateral circulation. When, how- 
ever, the embolus is lodged in a terminal artery of the basal sys- 
tem, or is carried beyond the circle of Willis, it causes first "red 
softening" of the neighboring brain-tissue, that is, the brain sub- 
stance appears swollen and discolored in different shades of red 
and is dispersed with numerous dots of blood ("capillary apo- 
plexies"). By and by the red color fades into yellow, partly 
from the absorption of the coloring matter of the blood, and 
partly from the ensuing fatty degeneration of the nerve elements ; 
this state of things is called "yellow softening." After a lapse of 
several months, if the patient lives that long, the affected tissue 
is converted into a semi-fluid milky substance, which is termed 
"white softening." At length even this may partially be absorbed, 
leaving a sort of cyst filled with quite thin fluid. 



The Predisposing Cause of embolism is preeminently acute 
rheumatism, and it is therefore found oftener in relatively youth- 
ful persons, while thrombosis has its predisposing cause in a mor- 
bid change of the vascular system, and is therefore oftenest met 
with in advanced years. 

Symptoms. — Embolism always sets in suddenly and very often 
with a condition, which resembles precisely that of an apoplectic 
stroke, without any premonitory symptoms. In some cases, how- 
ever, there is no loss of consciousness or coma; there may be 
delirium, aphasia, vomiting, paralysis — all disappearing in a 
few hours. 

Thrombosis comes on slowly with headache, dizziness and a 
sense of general confusion, loss of memory, numbness, coldness 
and creepings either in only one extremity, or throughout the 
distribution of one nerve, or in. one entire half of the body ; 
paretic and paralytic symptoms, perhaps with preceding slight 
convulsive movements, likewise confined to certain regions of 
the body and determined by the size and importance of the oc- 
cluded vessel. Finallj' the total occlusion may manifest itself 
with all the symptoms of an apoplectic fit, or may occur without 
any loss of consciousness: 

In the further course of development embolism or thrombosis 
may be described conjointly. Either of them may terminate in 
death or in complete recovery, or be followed by a repetition, or 
by a chronic development of symptoms as consequences of the 
structural changes within the brain above described. Only these 
latter symptoms concern us here. The temperature begins to rise 
on the second or third day and may quickly reach 104° F., when 
after two or three days it rapidly sinks again and finally becomes 
stationary. Indeed the complex of symptoms now developing 
may be regarded as identical with that of cerebral haemorrhage, 
and need not, therefore, be repeated. Aphasia is of very frequent 
occurrence in this affection, because the left Sylvian artery is the 
most common seat for embolic occlusions, inducing functional 
disturbances in that district of the cortex cerebri with which 
disorders of speech are regularly associated. 

The Diagnosis between embolism and haemorrhage is very diffi- 
cult, unless we can take the predisposing causes (valvular diseases 
of heart and affections of the lungs) as a starting point. A dis- 
tinction between thrombosis and haemorrhage is not possible, 
only that the first occurs much less frequently than the latter. 



APHASIA. 89 

THERAPEUTIC HINTS.— Compare Apoplexy and the various 
forms of meningeal affections spoken of before, to which I add 
the following remarks of Dr. H. R. Stiles: "When the disease 
shows evidence of inflammatory action, or is recent, BeUad., Nux 
vom., Mercur.; where it is evidently clue to atheromatous condi- 
tions of arteries, Phosphor., Phosph. ac, Anac, Zincum; for hemi- 
plegia, Nux vom., Coccul., Baryta carb., Arnica; for vertigo, Iodine 
(congestive); Sulphur, Digit, (cardiac); for sleeplessness, Coffea, 
Hyosc, or Nux vom., and Chamom., if the patient has been addicted 
to the use of coffee; China, if he has been a great tea drinker; 
for paralysis (general), Phosphor., Conium, Coccul., (local) Caustic, 
Aeon., Ignat, BeUad.; for convulsions (simulating epilepsy), Bellad., 
Calc. carb., Cuprum, Strychnine; for emotional disturbances, Ignat. ; 
headache (active), Aeon., Bellad., Bryon., Nux vom., Glonoin., (pas- 
sive) Gelsem., Opium; for imbecility, Arnica, Ambra, Selen., Sepia; 
or sensation of formication, Secale." 

Aphasia. 

Under this term clinical observers have arranged a variety of 
deficiencies of speech. 

"When there is an incapacity for the motor co-ordination, so that 
the patient, although he understands all that is said to him and 
is able to express his wishes by writing, is yet unable to express 
them by words, although his organs of speech — tongue, etc., — 
are in perfect order, it is called ataxia aphasia. Here the connec- 
tion between the idea and the organs of speech is interrupted. 
In some of these cases this does not amount to entire speechlessness; 
some words of one syllable may possibly be in his reach, and he 
uses them as best he can, making up by writing and gestures 
what he cannot convey by words; others utter only a few senseless 
syllables and tvords; but none can repeat words even if dictated to 
them. At times ataxic aphasia is complicated with agraphia, an 
inability to write either a single letter or a combination of letters into 
intelligible words and sentences, although otherwise the hands are 
fit to perform all sorts of other mechanical uses. The speech of 
gestures is seldom implicated in this affection. 

When there is an incapacity for the recollection of words, although 
the idea is present and the articulation is at the service of the word, it 
is called amnesic aphasia. Here the association between the idea 
and the word (its verbal expression) is interrupted. This occurs 



90 BRAIN. 

even during health. Sometimes, with our best endeavors, we can 
not recollect a name; in the diseased state especially novmi 
which cannot he roused into consciousness; therefore the pa- 
tient tries to describe what he means by other words, for in- 
stance calling a pair of scissors "that which cuts." Or it is only 
the initial letters which are wanting, and he omits them in speak- 
ing and writing; or in more profound derangements, although 
the patient may be able, by paying strict attention, to repeat 
what another speaks aloud before him several times, of his own 
accord he cannot utter it at all, or only badly articulated, mutilated 
and distorted. So also the letter-signs are either totally forgotten, 
or applied in unintelligible connections, while on the other hand 
the reading of written or printed matter may not meet any 
obstacles. 

When there is an inability to understand the words which they 
hear, or to read the words which then see, although sight or hearing 
and the ability to express their thoughts by speech and writing are 
unimpaired, it is called word-deafness and word-blindness (Kuss- 
maul). Here the association between the word (spoken or written) 
and the idea is impeded, or in other words the external stimulus 
does not reach the idea, while in the amnesic form of aphasia the 
idea is not capable of exciting its corresponding verbal expression. 
This affection, however, is generally combined with amnesic 
aphasia or agraphia, and patients of this kind have been taken 
for deaf and demented, because their answers did not correspond 
to the sense of the questions, and they used distorted or wrong 
words. 

When there is an inability to connect the ideas with their appro- 
priate word-expressions, so that instead of the appropriate term. 
another word of a different meaning or altogether strange and 
unintelligible expressions are used, it is called paraphasia. Here 
the connection between the ideas and their proper expressions is 
loosened, in a way that other words or names of ideas similar 
perhaps in meaning or sound interpose themselves and repress 
the proper ones. This disorder occurs at times without any 
pronounced morbid condition of the brain, when for instance 
from want of proper attention we use a word which belongs 
perhaps to another train of thoughts, but which at that time 
preoccupies the mind; or in the hurry of excitement, displace 
the consonants of certain words and form strange, irregular com- 
binations, say, for instance, "mood gorning" instead of "good 



APHASIA. 1)1 

morning," or instead of "Liebig and Mitscherlich," as an absent- 
minded professor did, "Mitschich und Liederlich." But in 
marked states of the brain this paraphasia confusion may amount 
to such total perversion and corruption of words and sentences 
that it is completely impossible for the hearer to understand 
what the patient means. And the same is true of paragraphia. 
"Royal naval medical office, etc.," one wrote in the following 
manner: "Roydudendd navendendd oforendendd, etc." 

By numerous post-mortems it is proved that lesions of the left 
frontal lobe, and especially its third frontal convolution are the 
most frequent Causes of aphasia; the island with the neighboring 
frontal, parietal and temporal districts comes next in frequency. 
Aphasias, from lesions in other regions are exceptions to the rule; 
as for instance the lesions of the right frontal lobe. These latter 
cause aphasia only in left-handed people, for the reason that such 
persons have exercised for speech and action the right frontal 
lobe; a lesion of the left frontal lobe does not affect their speech, 
since that of the right, which alone has been exercised, remains 
intact. Left-handed people, therefore, become aphasic only when 
the lesions include the right hemisphere; while lesions of the 
left lobe always cause aphasia in right-handed persons. 

These lesions for the most part consist of necrotic softenings 
from embolism and thrombosis of the artery of the fissure of Syl- 
vius; then follow in frequency in the order named haemorrhages, 
abscesses and tumors of this region. Aphasia is, therefore, merely 
a symptom of pathological conditions, most of which we have 
already described separately. Its Prognosis depends entirely on 
the severity of these conditions, and they ought to be studied 
thoroughly in any case of aphasia. 

THERAPEUTIC HINTS.— Here Ave must naturally refer to those 
already given under the corresponding chapters. Cases reported 
have been cured by : 

Bellad., compare symptoms under apoplexy. 

Conium, parenchymatous nephritis after scarlet fever. 

Glonoin., loss of memory for words and of the power to articulate. 

Kali brom., 3d trit., without symptoms mentioned. 

Lycop., confusion of thoughts ; forgetful ; mixed up letters and 
syllables of words in writing, or left out part of them. 

Stramon., in several cases used empirically with success. 



92 BRAIN. 

For additional hints compare the following collection of symp- 
toms : — 

Senseless after waking from a sleep at noon : Conium. 
Forgetful and absent-minded, with headache : Amm. carb. 
Cannot remember things which he wants to remember : Hyos. nig. 
Forgets names : Anac, Olean., Sulphur. 
Remembers having seen a person, but cannot remember her 

name: Crocus. 
All things appear new to him, after waking, even his friends : 

Stramon. 
Makes mistakes about time and objects, although they are quite 

clear and visible : Crocus. 
Unable to express himself properly while talking : Conium. 
Cannot talk connectedly : Canthar. 
nor express himself properly, with rush of blood to the 

head : Arg. nitr. 
Distracted, does not know what to say : Natr. mur. 
Slow remembrance, talks slow, hunts for the words when talk- 
ing: Thuja. 
Absentminded and forgetful : Alum., Bellad., Bovista., Coccul., 

Phosph. ac, Platin. 
with awkwardness in talking: Amm. carb., Xatr. mur., 

Sepia, Sulph. ac. 

and awkwardness in writing: Bovista. 

Inability to find the right words: Anac, Arg. nitr., Mercur., 

Pulsat. 

with stammering : Chamom., Opium. 

with making mistakes in writing: Chamom., China, Graphit, 

Hepar, Ignat., Xux vom. 
With headache uses wrong words : Caustic, Xux mosch., or 

has difficulty in talking : Thuja. 

Absent-minded, says what she does not intend : Xatr. mur., and 

makes mistakes in writing : Xatr. mur. 

Leaves words out when writing: Pvhodod. 

When he wants to write something down, he loses the ideas : 

Crocus. 
Forgetful, so that he cannot recall what he was about to write : 

Xatr. mur. 
He can express himself on abstract subjects very well : when 

talking about common things, he gets confused : Lycop. 
He cannot read what he wrote himself: Lycop. 
Difficulty in understanding what he is reading : Conium. 



THROMBOSIS OF THE CEREBRAL SINUSES. 93 

Thrombosis of the Cerebral Sinuses. 

The sinuses being of a rigid nature and incapable of collapsing, 
they being also traversed by bands of connective tissue, and hav- 
ing no muscular walls to promote the flow of blood, it is easily 
comprehensible, that in them a coagulation of blood may readily 
occur, if either the propelling power of the heart, the vis a tergo, 
should become weakened, or there should form obstacles to the flow 
of blood in the sinuses themselves by inflammation of their walls 
{phlebitis). The first usually occurs under conditions as are 
known by the name of marasmus, particularly common among 
children during their first year of life, when they are prone to 
sudden collapse induced by severe diarrhoeas; also in adults 
through the influence of various conditions which induce enfee- 
blement of the propelling force of the heart, such as profuse 
suppuration, cancer, marasmus senilis, etc. This form of throm- 
bosis is especially found in the longitudinal sinus and in the 
transverse sinuses, and is called marantic thrombosis. 
, The second or phlebitic form originates most commonly from 
disease of the cranial bones, especially of the petrous portion of the 
temporal bones which accompanies otitis media; then its seat is in 
the neighboring sinuses — the sinus trans versus and petrosus; if 
phlebitis arises from caries of other cranial bones, or large furuncles 
in the face, especially on the upper lip, or erysipelas of the head 
and face, its seat is determined by the location of these lesions. 

The Symptoms of marantic thrombosis when accompanying con- 
ditions of marasmus in children, resemble greatly those of hydren- 
cephaloid, both giving rise to cerebral anaemia; collapse, followed 
by somnolence and coma is common to both. As a general 
rule of distinction between the two, the following may be laid 
down : If diarrhoeas, occurring in children a few months old, are 
followed by cerebral disorders of the active motor kind, such as 
rigidity of the muscles of the neck and sometimes of the back, 
and even of the limbs, sometimes nystagmus, the probability 
speaks for thrombosis of the superior longitudinal sinus; whereas 
the clinical history of hydrencephaloid usually closes with col- 
lapse, somnolence and coma, terminating either in death or re- 
covery ; convulsions or paralysis are only exceptionally met with. 

Marantic thrombosis in adults is in its manifestations still more 
indefinite. It may show nothing but a slight degree of apathy 
and general depression, a varying complex of symptoms of dif- 



94 BRAIN. 

fused, undefined cerebral diseases, such as headache, delirium, 
loss of consciousness, disturbance of the motor functions either 
of the spasmodic or paralytic kind. In some cases, however, 
symptoms occur in children as well as in adults, which are 
diagnostic, namely : swelling of those veins outside of the skull, which 
communicate with the affected sinuses; epistaxis ; tensely filled 
vessels, running from the anterior fontanel to the neighborhood 
of the temples and ears on both sides; cyanosis of the face, all this 
in case of thrombosis of the superior longitudinal sinus. 

When the transverse sinuses are affected, there may be oedema 
limited to the parts behind the ears; or the internal jugular vein 
may be found less filled on the side of the lesion, than on the 
other side, but this symptom is not often so prominent that it 
could be turned to account. 

When the sinus cavernosus is' the seat of the disease, there 
usually exists hypersemia of the fundus ocali, oedema of the eyelids 
and conjunctiva, and prominence of the eyeball; sometimes on ac- 
count of the pressure upon the first division of the trigeminus, 
the trochlearis, the abducens, and the oculo-motorius, paralysis 
of the motor nerves, or neuralgia or trophic disturbance of the 
eye may arise. 

Sometimes particles from the thrombi are carried off by the 
blood-current and become lodged in the lungs. If such pul- 
monary embolism are found under conditions above described, it 
would be another sign in favor of the conclusion, that thrombosis 
of the cerebral sinuses actually exists. 

The Prognosis of this affection is decidedly unfavorably, and 
in regard to therapeutic hints, I must refer to hydrencephaloid, 
anaemia, summer-complaint, inflammation of the inner ear and 
other affections which are more or less related to this affection. 

Hypertrophy of the Erain 

Means an overgrowth of the brain. However, we ought to know, 
that it is not the cerebral substance itself, which develops more 
largely, than naturally, but that it consists of an undue growth 
of the interstitial tissue which binds the nervous elements to- 
gether. It is confined mostly to the cerebrum ; yet there are a 
few cases in which the cerebellum has also been said to be af- 
fected. Partial hypertrophy is still more rare, and, in part, of 
very doubtful nature. 



HYPERTROPHY AND ATROPHY OF THE BRAIN. 95 

On post-mortem examination the brain is observed to swell' 
out from under the removed bone above the skull bones. The 
adjustment of the removed bones to their original position is 
quite difficult. The membranes are thin and bloodless and be- 
tween the arachnoidal spaces there is no cerebro-spinal fluid. 
The convolutions on the surface of the cerebral hemispheres are 
flattened and compressed, and 'the sulci between them scarcely- 
noticeable. The ventricles are narrow and the substance of the 
brain itself is anaemic, but its consistence and elasticity is greater 
than in a normal brain. 

This abnormal growth is either congenital (and then is fre- 
quently combined with an imperfect growth of the body), or it 
develops itself after birth, mostly during early childhood, rarely 
afterwards. In the latter case, we find it frequently associated 
with rhachitis and enlarged lymphatic glands. Its Causes are 
unknown. Its external Symptoms are: a considerable enlarge- 
ment of the head, if it takes place before the sutures of the skull 
are perfectly closed ; a condition entirely similar to that in the 
enlargement of the head in consequence of hydrocephalus. When 
it takes place after the closure of the sutures, such extension is 
impossible, but the skull bones grow thinner and their inner 
layer becomes roughened by absorption. In the first place it can 
be distinguished from hydrocephalus by this fact: that children 
having this affection are rather forward in their mental develop- 
ment, while in hydrocephalus the reverse always obtains. A 
hypertrophy after the closure of the sutures is never recognizable 
with certainty. One of its most important symptoms, however, 
are frequent attacks of fits, which resemble epilepsy. 

THERAPEUTIC HINTS cannot be given a priori. Each individ- 
ual case must be studied by itself. Compare Hypersemia. 

Atrophy of the Brain 

Is the opposite of hypertrophy, a shrinking, wasting away of the 
brain. 

Deficiencies of growth have been found congenital, being con- 
fined either — 1, to both hemispheres of the cerebrum ; or, 2, to 
both hemispheres of the cerebellum ; or, 3, to certain parts of the 
brain which are not developed at all. In such cases the children 
are idiots. In some other cases the deficiency has been found 
confined — 4, to one-half of the cerebrum and to the opposite half 



96 BRAIN. 

of the cerebellum, (the usual condition), or to the corresponding 
half of the cerebellum; then the children are not idiots, but 
mostly affected with hemiplegia of the opposite side and in a 
great many cases with epileptic fits. This deficiency, in the proper 
development of the brain, the causes of which we do not know, is 
called agenesia. 

Real atrophy is a shrinking — wasting away — of the cerebral 
substance. It occurs, occasionly, in old age, in consequence of 
marasmus senilis, where a want of general nutrition causes a 
waste of the brain ; the lost substance being at once replaced by 
an exudation of serum, constituting hydrocephalus senilis. It 
also occurs as a result of exhausting diseases and chronic alco- 
holism ; almost always leading to general paralysis and imbecility 
of mind. 

But it may develop itself in portions of the brain only — partial 
atrophy — when in consequence of apoplexy, inflammation or ex- 
udation, as we have already seen, by destruction or pressure upon 
the capillaries or arteries, such portions become deprived of the 
necessary nutrition. Its consequences are, in almost all case?, 
aberrations of the intellect, imbecility of mind, and paralytic 
affections. 

THERAPEUTIC HINTS.— A deficient development of a portion 
of the brain can not be remedied; congenital deficiencies are there- 
fore clearly out of the reach of any medicine. "Where we suspect 
an atrophy in consequence of exhausting disease, we must select 
our remedies according to these circumstances. Destroyed por- 
tions will ever remain destroyed in spite of medicine. 

Dementia Paralytica 

Is understood as "a diffused disease of the brain and often also of 
the spinal cord, which is characterized by a peculiar combination 
of physical changes with motor disturbances in the muscles of 
different parts of the body, which has a chronic course and ends 
in death." (Hitzig). 

In the protracted cases post-mortem always shows atrophy of 
the brain, which can be recognized by inspection and frequently 
by weight. The dura lies in folds over the frontal lobes: the pia 
is either locally or universally cedematous; the ventricles are en- 
larged ; the dura often adheres so firmly to the skull that it can- 



DEMENTIA PARALYTICA. 97 

not be removed without injuring the brain; it may present all 
varieties of dulness, thickening and deposits upon its surface, 
also innumerable larger or smaller flattened extravasations, 
which have all shades of color between yellow, red and black ; 
even large hematomas have been found; yet there are numerous 
other cases in which the dura appeared intact. The brain-tissue 
by microscopical examination reveals a chronic or sometimes a 
sub-acute interstitial (peri) encephalitis, which in course of time 
leads to destruction of the ganglion cells and to atrophy of the 
brain. The spinal cord presents gray degeneration of the poste- 
rior columns or granular cell myelitis; the membranes of the 
spinal cord undergo, though more rarely, changes, similar to 
those of the brain. 

As predisposing Causes heredity has been mentioned. Probably 
the combination of excessive labor with excesses in Baccho and 
Venere is the most common cause, although injuries of the head, 
constitutional syphilis and the influence of acute febrile diseases 
may also give rise to the development of this disease. It scarcely 
occurs under the age of twenty; is most frequent between thirty 
and forty-five or, according to some authors, between fifty and 
sixty years of age. 

Its Prodromal Symptoms, which sometimes for years precede 
the final outbreak, are the most important for the physician, be- 
cause then and there lies his only chance of preventing greater 
mischief. Spells of dizziness, which pass over quickly; of headache, 
more or less severe and worse in the morning ; of rheumatic pains, 
especially in the lower extremities, changing location and com- 
ing and going suddenly, worse at night. With these chance 
symptoms appear an unusual irritability of character entirely 
foreign to the patient's former behavior, and a weakness of memory, 
especially for recent events, while past ones are well remembered ; 
he often forgets his hat, his cane, or pocket handkerchief, etc. ; 
the muscles around his mouth occasionally are seen to tremble 
either spontaneously or when other facial muscles are in action. 
The patient is unconscious of it, and recognizes the fact only 
when he sees it in the mirror ; his speech becomes nasal, or diffi- 
cult and imperfect, especially iii regard to the labials and sibi- 
lants; a kind of lisping as if slightly intoxicated; the tongue 
trembles, and the voice changes. Apoplectic attacks are often 
the commencement of the disease. 



98 BRAIN. 

In its further progress the patient shows peculiar exaggerated 
ideas of his own importance or greatness, he possesses a thousand 
or a million horses, a thousand million dollars, etc., and although 
now it may be proved to him, that he is wrong, he immediately for- 
gets all about it, and gradually falls into an idiotic silliness from 
the weakness of memory, which was one of the very first symp- 
toms of the disease. He also gradually loses his affection for 
his family and before his friends may have become aware of his 
unaccountableness, he may have squandered away the very 
subsistence of his family. Sometimes there are outbursts of anger 
amounting to blind rage, making him dangerous to those around 
him, and in other cases we meet with depressing, hypochondria- 
cal, melancholic states of mind, which again may interchange 
with conditions of excitation. So also is kleptomania of frequent 
occurrence ; the patients pocket things without in fact knowing 
it, or carry them away openly, because they believe they are mak- 
ing use of their own property. 

The Motor Changes consist either of disturbances of co-ordina- 
tion — staggering when the eyes are shut; jerking, uncertain gait, 
difficulty of turning round, peculiar trembling, jerky handwrit- 
ing — when there is gray degeneration of the posterior columns — 
or shuffling, awkward, helpless gait, unsteadiness on attempting 
to turn quickly, but no increased swaying of the body when the 
eyes are shut — when there is granular-cell myelitis. More or less 
complete, persistent, unilateral facial paralysis is often noticed, 
and if apoplectic attacks repeat, they leave behind hemiplegia 
which may disappear again, while the intelligence degenerates 
so much more quickly; or the attack is often combined with 
unilateral or general epileptiform spasms, ending occasionally in 
death. Anaesthesia, persistent and extreme, is found in all cases, 
when far enough advanced. 



Senile Dementia. 

"To be perfectly candid, we must confess that there is not a 
single symptom which is so pathognomonic of general paralysis 
that it may not be found also in senile dementia, and excepting 
the peculiar weakness of memory, in alcoholism also ; and even 
the grouping of the symptoms as a whole may in the two latter 
diseases be such as to afford an entire analogy with undoubted 
cases of general paralysis. In senile dementia the course of the 






SENILE DEMENTIA — DEMENTIA PARALYTICA. 99 

affection itself often enough furnishes no definite conclusion, 
while alcoholism certainly affords a much more favorable 
prognosis." 

'• Only those cases can with certainty be considered as senile 
dementia in which advanced age, want of motor disturbances, or 
the presence of very marked hemiplegia, and, finally, absence of 
the extravagant delirium of grandeur, are all found associated. 
The delirium of old age is, as a rule, almost invariably of a more 
childish nature, while it is concerned with the most diverse sub- 
jects. Besides, epileptiform attacks almost never occur in the de- 
mentia of age and the apoplectic attacks of these old people are 
accompanied with serious permanent paralysis, if they do not end 
in death. Finally, the course of senile dementia is regular, less 
broken by remissions and intermissions. Nevertheless, that is an 
uncertain criterion and the same may be said to a still higher 
degree of all the other diagnostic points mentioned above." 
(Hitzig.) 

THERAPEUTIC HINTS.— The following are taken from Dr. S. 
Lilienthal's treatise on dementia paralytica in the November 
number of the Hahnemannian Monthly, 1876. 

For the remedies which hold out some hope, let us study that 
classical work, Hering's Analytical Therapeutics, where we read 
(1. c, pp. 114 and 115) for headache with ill-humor, and especially 
in the forenoon : Amm. carb., Platina, Kreos., Petrol., Stannum 
(gradual increase and gradual decrease), Phosphor., Calc. phosph.; 
for headache with diminished intellectual power, Phosphor., Nux 
mosch., Sarsap.; for forgetfulness, Amm. carb., Capsic. Caustic, 
Mezer., Moschus, Viol. od. ; sensation in forehead as if the skin were 
too tight, with anxiousness, Phosphor.; sensitive to light, fretful, dis- 
contented, complaining, Arsen.; oversensitiveness of hearing, Carb. 
veg.; noise unbearable, ivith anxiety, Aurum, Capsic, Caustic, 
Petrol., Pulsat.; fear, with noise in the street, Caustic; cannot move 
the tongue right, with anxiety, Caustic; difficult speech, Caustic; ab- 
sent, loses the train of ideas, Amm. carb. (p. 247); convulsions with or 
without conscious7icss, Kali carb., Lycop., Nux vom., Platina, 
Plumbum; irritable, discontented, Nux vom.; idiotic condition 
before the attacks, Caustic. ; bodily and mental infirmity, Natr. carb. ; 
lassitude in the limbs, with indisposition to work, Amm. carb.; men- 
tal and physical prostration in the morning, Laches., Phosphor.; las- 
situde with irritability, Ambra, Calc. carb., Carb. veg., Caustic; 



100 BRAIX. 

bodily weakness, with its increase memory declines, Nitr. ac; mental 
dulness with prostration, Alum., Anac, Aurum, Digit; nervous af- 
fection with mental listlessness, Nux mosch.; no ambition, tires soon, 
Nux vom.; indisposed to work or walk, Zincum ; heaviness of mind 
and body, Phosphor., Phosph. ac. ; sleep disturbed by restless dreams, 
Arsen. ; sleeplessness before midnight, Arsen., Kali carb., Pulsat., 
Veratr. ; weak memory, Carb. veg. ; periodical mania, Arg. nitr. 

Symptoms of mania eh grandeur we find under Cuprum, Platina, 
Lycop., Laches., Stramon., Veratr. 

Symptoms of extravagance under Amnion., Bellad., Caustic, 
Chinin., Iodine, Petrol., Phosph. ac, Platina, Stramon., Sulphur, 
Veratr. 

Obtuseness of intellect with obscuration of eyes, Carb. veg. 
■ Weak memory, for correct writing, Laches.; for what has hap- 
pened, Graphit, Natr. mur., Sulphur; for words, Baryta, Lycop.; 
on awaking, Stannum ; with debility, Nitr. ac; with headache, 
Kalmia, Moschus. 

Sensitiveness of the cars to noise, with anxiety, Capsic; with ill- 
humor, Bellad., Phosphor. 

Distortion of the mouth, Bellad., Graphit,, Laches., Lycop., Nux 
vom., Opium, Phosph. ac, Secale, Stramon. 

Dilatation of pupils, Bellad., Calcar., Crocus, Hyosc, Xux vom., 
Opium. 

Difficult speech, Bellad., Caustic, Laches., Xux vom., Opium, 
Sulphur, Stramon., Veratr. 

Kleptomania, Sulphur, Pulsat., Arsen.. Bryon., Kali, Lycop., 
Nux vom., Sepia. 

Doxomania, conceited mania, Platina, Cuprum, Hyosc, Laches., 
Lycop., Stramon., Veratr. (2.) Alum., Arnica. China, Conium, 
Ferrum, Ipec, Paris, Phosphor., Secale. 

Epileptic jits as a complication, Arsen., Bellad., Calcar., Cuprum, 
Hyosc, Ignat, Laches., Mercur., Opium, Xux vom., Plumbum, 
Pulsat., Sulphur. 

Caustic. — In the disease, as well as in the remedy, we find from 
the start great melancholy, looking on the dark side of every- 
thing, facial neuralgia and facial paralysis, weakness of voice, 
and other paralytic affections. Hahnemann ( Chronic Diseases, iii. 
78) gives us the hypochondriac depression of spirits, peevishness, 
dull, gloomy, pressure on the brain making the head feel obtuse, 
vertigo, incipient amaurosis, roaring and buzzing in the ears, 
rheumatic and arthritic affections of all kinds, tremulous weak- 



DEMENTIA PARALYTICA. 101 

ness, epileptic convulsions, prosopalgia, paralytic affections, espe- 
cially of one side. Allen (Encyclopedia, iii) gives us the whole 
complex of symptoms ; the tearing, lancinating pains of the ex- 
tremities, muscular twitchings, and excessive weariness in both 
limbs, especially in the morning in bed; attacks of spasms, in 
the morning in bed, sometimes with consciousness, at other times 
with unconsciousness; peevish, irritable mood, fretfulness, indo- 
lence, slow succession of thoughts, absence of mind with loss of 
ideas, weakness of memory (but no insane delusions are found 
under Caustic); vertigo forward and sideways, at night in bed; 
vertigo, almost like a loss of consciousness, while sitting he nearly 
fell; constrictive pressure in the forehead; tensive headache 
arising from the nape of the neck; indistinct vision, it seems as 
though a thick cloud hovered before the eyes ; spasmodic sensa- 
tion in the lips, etc., etc. 

Amm. carb., gloomy and uneasy mood, aggravated by cloudy 
weather ; low spirits, with considerable excitement ; very forget- 
ful, and headache when reflecting ; absence of mind, with anxi- 
ety ; speaks and writes incorrectly ; weight and confusion of the 
head ; vertigo, as from intoxication ; great lassitude, and disin- 
clination to all work ; most severe muscular contractions, spasms ; 
violent rheumatic drawing pains through all the limbs, hands, 
feet, nape of the neck, head, etc. 

Laches, for persons with a melancholic or choleric tempera- 
ment, with a phlegmatic spongy constitution; with dark eyes 
and disposition to lowness of spirits and indolence; for acute 
and chronic rheumatism, recurring every year; for emaciation 
and exhaustion; for hemiplegia; for convulsions and epilepsy. 
Among its symptoms we read: Indolent, taciturn, brooding and 
melancholic; he considers himself too feeble to do anything, with 
aggravation of the symptoms every other day; great absence of 
mind; great weakness of memory, he forgets entirely what he 
had been hearing a moment before; frequent mistakes in writing; 
vertigo, with staggering to the left side, early in the morning 
after rising ; deep stinging through the whole head ; deep-seated 
headache; sensitiveness of the eyes to light; dim and weak eyes; 
very sensitive to noise; prosopalgia; distortion of mouth and 
lips; difficulty of speech, as if the tongue were too heavy; rheu- 
matic pains extending from the back to the limbs; difficulty of 
falling asleep for weeks ; no sleep in spite of great lassitude ; con- 
stant exhausting sleeplessness; aggravation of all complaints 



102 BRAIN. 

after sleeping; painful wandering of the pains from one part to 
another; awkward, stumbling gait; hemiplegia; typical recur- 
rence of the aggravations. 

Nux vom. exactly suits such cases which owe their origin to 
sexual excesses and immoderate intellectual exertion, and also to 
persons of middle age, especially when they have changed their 
former busy life for a quiet one. The old school also claims to 
have derived many a benefit from hypodermic injections of mini- 
mal doses of Strychnine in this disease; and wherever the pro- 
dromal and even the first stage last a good while, Nux may be 
the simile to the existing stage of the disease. Among its symp- 
toms we find : Periodical affections of the nervous system ; tear- 
ing, drawing-tensive rheumatic pains, with weakness and feeling 
of numbness in the affected parts ; hypersesthesia of the nerves 
of the senses; tonic spasms and convulsions; emotional epilepsy; 
central softening of the spinal cord (here also the gray matter) ; 
paralysis of the upper and lower extremities; periodical head- 
ache, gradually increasing, and after reaching its acme, gradually 
decreasing; dulness of mental powers; obscuration of sight; pa- 
ralysis of the tongue, with difficult and indistinct speech, in con- 
sequence of cerebral apoplexy. The irritable temper of Nux is 
well-known, and even for the second stage of the disease we find 
corresponding symptoms, as awkwardness, he easily stumbles 
against something; makes mistakes in speaking and writing (cer- 
tainty cerebral functions); compression of the head as from 
nightly revelling; chronic vertigo, with obscuration of sight and 
buzzing in the ears; twitching of the facial muscles; distortion 
of the mouth to one side, etc. 

Phosphor, is the grand remedy for a weak, exhausted brain- 
Here we have to deal with a disease whose whole tendency is to 
degeneration of the nerve-mass, to atrophy of the brain, and we 
might with certainty expect some benefit from a remedy which 
causes fatty degeneration throughout the body. Among its 
symptoms we find: Great lowness of spirits; great irritability; 
forgetful and dizzy; vertigo; dull, stupefying headache; con- 
strictive headache every other day; frequent attacks of sudden 
blindness in the daytime, and sensation as if a gray cover were 
hanging over the eyes; constant buzzing in the ears; pale, sickly 
complexion; great weariness in the extremities; sleeplessness and 
restlessness; heaviness of mind and body; exaggerated ideas of 
his own importance; monomania le grandeur et de la richesse; 



DEMENTIA PARALYTICA — DELIRIUM TREMENS. 103 

forgets names and what has happened recently ; unconnectedness 
of ideas when writing or talking; lastly silliness; idiocy. 

Aurura. The suicidal melancholy of Aurum seems to mark a 
contraindication for this remedy in any stage of this disease, 
certainly during the expansive delusions. During the conse- 
quent stage of apathy and palsy it can hardly be indicated; still 
it was prescribed by close observers on account of the venous 
hyperemia in the brain. We here find hypochondriasis, but 
not melancholia so much ; the epilepsy rests upon a very material 
basis; the exhaustion is a natural consequence of premature 
senility, hence the disgust of life, and we mention it only as hav- 
ing many symptoms in common with the prodromal stage, but 
the causes being so often different, it will be only in rare cases of 
real benefit. It may alleviate, but will not stay the ravages of 
this disease. 

Cuprum. — "What Zincum is for later stages, Cuprum might be 
for the prodroma. According to Schmid, of Vienna, all the cere- 
bral disorders cured by Cuprum are of the reflex order, which 
would limit the applicability of Cuprum in dementia paralytica 
to very rare cases; still, Rademacher's indication, when there is 
premature exhaustion of strength in illness, may point towards 
its use in patients of neurotic temperament, especially where 
heredity can be shown. 

Silicea. — Carroll Dunham, in his usual masterly manner (N. A. 
J. of H., xx, 361), thus describes the action of Silicea on the ner- 
vous system: "With evidence of exhaustion, furnished by sensa- 
tion of weakness, paralysis, etc., there is an exalted condition of 
susceptibility to nervous stimuli ; the special senses are morbidly 
keen, the brain cannot bear even moderate concussion, and the 
whole surface is unnaturally tender and sensitive; cold aggra- 
vates and warmth relieves. There is an erethism, conjoined with 
exhaustion, which is not evanescent, but endures for some time." 
Certainly such a remedy promises much in the prodromal stage 
of our disease, and carefully studied and applied in the right case 
may fulfil this promise and lead to a cure. 

In addition I may recommend to compare corresponding chap- 
ters, previously treated of, and also chronic alcoholism. 

Delirium Tremens. 

Delirium tremens is an acute form of chronic alcoholism, which 
breaks out either during and in consequence of excessive use of 



104 BRAIN. 

alcoholic drinks, or follows the sudden deprivation of stimulants 
in the case of habitual soakers. 

Without any marked prodromal symptoms, it commences with 
hallucinations of vision (the seeing of beetles, rats, birds, serpents 
and the like, or other horrid images such as great black beasts, 
the devil, or a persecuting officer, etc.,) hallucinations always 
characterized by their unsteadiness and horrid nature. If the 
sense of hearing is affected, its hallucinations are likewise of a 
horrid nature, although in some cases music, songs and other 
pleasant things are heard. Sometimes the patients feel as if they 
were enclosed in a fine net of spun glass or of some textile fabric, 
or as if little insects were crawling under their skin. They move 
their hands and fingers objectlessly about, or act as if they were 
removing small objects from their body or bed. Their eyes look 
unsteady and wild and sometimes they even have nystagmus. 
Consciousness they lose seldom or only for a very short time, and ■ 
therefore answer questions for the most part correctly. They are 
very restless, are very much troubled by their hallucinations and 
sleep never touches their eyes. In some cases they become 
violent, destructive, maniacal. Tremor, more or less extensive 
and violent is present in some and absent in other cases, as also 
tetanic and eclamptiform convulsions have been observed in 
some cases. Individual cases, however, vary greatly. All symp- 
toms are worse during the night, and the attack lasts from a few 
days to a fortnight. Post-mortems have shown pigmented and 
thickened mucous membranes of the stomach, fatty degener- 
ation of the liver and kidneys, pachymeningitis, and dryness 
and ansemia of the brain. 

THERAPEUTIC HINTS.— If the attack sets in during debauch, it 
may be well to apply the stomach-pump, in order to rid the 
stomach of its alcoholic contents. It is also benefical to urge the 
patient to drink cold water and skimmed milk as much and as 
often as possible, in order to thin the alcoholic poison. One or 
the other of the following remedies will then act so much the 
more favorably. 

Act. rac, restlessness and fear of death. Hale: "nausea, retch- 
ing, dilated pupils, tremor of the limbs, incessant talking and 
changing from one subject to the other; sleeplessness; imagines 
strange objects, as rats, sheep, etc.; quick, full pulse, and peculiar 
wild look out of the eyes." 



DELIRIUM TREMENS. 105 

Agar., no clinical cases as yet but its symptoms call loudly for 
its mention in this place. 

Arsen., great restlessness anxiety and oppression with cold per- 
spiration; hallucination, especially at night; pale or yellowish 
color of face ; eyelids red on edges ; no appetite, great thirst ; 
vomiting every morning; region of liver painful and swollen; 
stool retarded and as if burnt, or violent diarrhoea. For sots who 
have had attacks before. 

Bellad., young persons with congestion to the head and excita- 
bility of the sensorium; want of memory; sparks like lightning 
before the eyes ; anxious and unsteady, walks about as if busy 
and cannot be persuaded to desist of doing different things; 
imagines he sees water running over the table, or panes of glass, 
cats, etc.; wants to extract a tooth, and reaches for that purpose 
in his mouth: stammering, indistinct speech with a constantly 
smiling face ; dry feeling in the throat, with difficult deglutition 
and violent thirst. Jerking of limbs ; cramps in the calf of the 
legs ; trembling of hands. 

Calc. carb., hallucinations of fire, murder, rats, mice, etc. ; red 
face, dilated pupils; hallooing, screaming, restless; pulse soft, 
full and frequent ; skin moist ; tongue coated whitish ; consti- 
pation. 

Cann. ind., when the illusions both of sight and hearing are 
characterized by taking the form of tremendous magnitude, so 
that a step appears to him as an enormous distance, or a small 
noise as a tremendous sound. 

Coffea, thinks he is not at home ; walks restlessly about ; no 
sign of feeling sleepy ; quick pulse and trembling hands. 

Ciotal., constant drowsiness, with inability to sleep, after Hyosc. 
had failed. 

Digit., in cases which come on slowly with gradually increas- 
ing pain in pit of stomach, continuous nausea, thirst, palpitation 
of the heart, gastric headache, vertigo and paleness of face. 

Gelsem., produced- sleep, after morphia had failed. 

Gratiola, successful in cases where the delirium assumes the 
character of anger rather than of anxiety, in subjects not yet 
greatly exhausted. 

Hyosc, epileptiform fit precedes the attack ; continuous talking 
at night; wants to run away for fear of being persecuted by the 
police ; tremor of limbs. 

Ignai, chorea-like and epileptiform convulsions ; paresis ; an- 



106 BRAIN. 

aasthesia combined often with hyperoesthesia of the legs ; sub- 
sultus tendinum ; jerking of the limbs; trembling of the tongue. 

Kali brom., in first stage with horrid illusions, flushed face, red 
eyes and hard and quick pulse. (Crude doses). 

Nux vom., most frequently applied. Indescribable anxiety ; 
finds no rest in any place ; sees different images ; congestion to 
the head ; face pale and bloated ; tongue coated white or brown, 
dry and thirsty ; nausea and bitter vomiting ; vomiting in the 
morning; pressing pain in stomach and region of liver; trem- 
bling, cannot bring the glass to his lips without spilling its con- 
tents ; aversion to coffee ; constipation or diarrhoea. 

Opium, preceded by epileptiform fits; imagine they see frightful 
objects, and are in great fear ; believe themselves to be murderers 
or criminals who shall be executed ; want to run away. Staring 
look ; twitching of the muscles of the face and mouth ; lockjaw ; 
tremor. Reduced subjects. 

Stramon., frightful visions of animals which appear to jump up 
at his side; imagines one half of his body being cut off; hallu- 
cination of hearing, as if on the right side of the occiput a loud 
voice were abusing and insulting him : wants to run away ; uses 
wrong words when talking; glistening, staring eyes, with en- 
larged pupils ; tremor of all the limbs. 

Tart, em., after excessive drinking of young persons ; gnawing 
pain in the stomach. 

Zincum, great fear, as if persecuted by men or the devil, on ac- 
count of crimes which he has never done ; is afraid of becoming 
imprisoned, or poisoned, or shot, or buried alive, with great ex- 
citation, pappy taste, whitish coated tongue, eructations, loss of 
appetite, retarded stool, vertigo and heat in head and face. 

Chronic Alcoholism ; Dipsomania. 

It is without exception the consequence of long-continued and 
continuous abuse of spirits, and although persons of this category 
are seldom seen in a state of actual drunkenness, still their whole 
system is shattered and shaken to its very foundation. They 
lose their character; their craving for drink overrules their best 
intentions, they continually struggle with temptation and yield 
continually to it; they feel themselves in a continuous conflict 
and dissension with their own better selves, and gradually fall in 
a state of deep melancholy and suicidal tendency from which 






CHRONIC ALCOHOLISM. 107 

only a fresh resort to their one remedy, whisky, liberates them 
for the time being. And as they grow from bad to worse, the 
higher they stood, the lower they fall, until at last they do not 
shrink from committing crimes in order to gratify their un- 
governable craving. 

Dipsomania occurs in the form of a repeatedly recurring rage 
for drinking, which often is preceded by unpleasant sensations 
in the lower part of abdomen, nausea, vomiting, want of appetite, 
general depression, gone feeling all over, and trembling sensa- 
tion about the heart. This condition often terminates in an at- 
tack of madness. 

The psychical degeneration, which differs in different patients, 
produces varied forms of insanity : sometimes forms of exaltation 
with changing and absurd delusions, sometimes forms of melan- 
choly with religious mania, delusions of persecution, and some- 
times mere tranquil dementia. Besides these psychical disorders 
we find others affected with different degrees of paralysis of mo- 
tion and sensation. Paralytic dementia is one of the commoner 
terminal diseases of chronic alcoholism, as also apoplectic and 
epileptic attacks occasionally occur during its course. In some 
patients color-blindness of green and bluish-green, amblyopia 
and amaurosis in various degrees with atrophy of the optic nerve 
has been observed. The chief ailment, however, is a chronic 
gastric catarrh, which makes digestion almost an impossibility 
and interferes entirely with the general nutrition of the body. 
We therefore find the liver almost always affected, ending in cir- 
rhosis; the kidneys suffer with morbus Brightii, and some patients 
die with ansemic symptoms. The sexual functions are at first 
little affected ; in one case, I know of, the sexual desire is almost 
hightened to satyriasis; in the later stages, however, sterility 
attacks both sexes. The children of alcoholic parents exhibit 
very often a predisposition to psychical disorders and inherit a 
badly constituted nervous system. Children begotten in drunken- 
ness are said to be epileptics from their birth. 

The post-mortem appearances vary greatly ; there have been 
found : pachymeningitis hemorrhagica ; atrophy of the cortical 
substance ; fatty degeneration of the ganglionic cells, of the vol- 
untary muscles, of the heart, liver and kidneys ; thickening of 
the coats of the veins ; thickening of the mucous membrane of 
the stomach and sacrum ; flat erosions, hypersemic vessels and 
increased pigmentation- of the mucous membrane of the stomach; 



108 BRAIN. 

granulated condition due to interstitial development of increased 
connective tissue or cirrhosis of the liver. 

THERAPEUTIC HINTS.— Confirmed drunkards are no doubt hard 
cases to manage. Some we will not be able to reform, unless we 
can take them entirely out of their wonted associations and sub- 
mit them to moral treatment; others probably may be approached 
if we succeed in producing in them a disgust for whisky, and ac- 
custom them to the use of milk as main diet. Still others, per- 
haps all, will be relieved of many of their symptoms by a careful 
selection of one or the other of the following remedies. 

Angelica, in 15 drop doses of the tincture, three times a day, has 
caused disgust for liquor. 

Amm. carb. et canst, in nervous, torpid asthenic cases ; in peri- 
odical hallucinations ; in amblyopia. 

Arnica, during the delirium, when he imagines that he will be 
arrested; also when after the cessation of trembling, formication 
and subsultus tendinum there still remains a weakness or sense 
of being asleep of the whole muscular system, slowness of com- 
prehension, ringing in the cars or fog before the eyes. Taken 
in the first dilution, it has also caused a decided disgust for 
liquor. 

Arsen., cachectic paleness; habitual redness of the conjunctiva; 
sudden loss of strength ; anxiety in pit of stomach; great restless- 
ness; affections of the heart; oppression of the chest, even suf- 
focative spells, especially on moving and at night ; emphysema 
of the lungs; dry cough, or difficult, tough expectoration. Nausea 
and vomiting; great thirst; tongue dry and intensely red at least 
on point and edges, or whitish coated; watery diarrhoea, worse 
after midnight. Tobacco ch ewers. 

Carb. veg., digestive troubles, with burning in stomach : heart- 
burn, acidity, belching of rancid taste, all worse after eating ; re- 
tarded stool, hard and insufficient; cachectic paleness oi face; 
chilliness. 

China, lienteric diarrhoea; dropsical affection; exhaustion. 

Ferr. met, earthy paleness of the face, or bloated face, easily 
reddening; roof of mouth always pale. Vomiting of food un- 
digested ; hydrcemic conditions. 

Kali bichr., especially in complaints of beer-drinkers. 

Kali brom., headache, with dizziness: staggering as if intoxi- 
cated ; stupefaction ; sopor ; muscular weakness ; anaesthesia of 



CHRONIC ALCOHOLISM. 109 

pharynx and velum palati and external skin; sight weakened 
and hearing impaired. Gastralgia ; vomiting ; colic ; consti- 
pation. 

Kreos., habitual vomiting of undigested food ; of large quanti- 
ties of sour, acrid fluid, or of white, foamy mucus ; diarrhoea pro- 
fuse, colorless, or greenish watery, fetid. 

Laches., worse in the afternoon or after sleep; constant talking 
and jumping from one subject to another; cannot bear anything 
tight around the neck; great weakness ; tremor of hands; liver 
affections. 

Natr. mur., hypochondriacal melancholy; headache (migraine); 
thin, nervous individuals prone to outbursts of passion ; craving 
for liquor ; digestion easily disturbed by slight dietetic or mental 
causes, with furred tongue, or map tongue; great thirst; slow 
digestion; vomiting of clayey substances; stool hard and re- 
tarded ; venous congestion of liver, pancreas and uterus ; flutter- 
ing of heart; cutting pain in urethra after urination. 

Nux mosch., dulness, heaviness and pressure in the head ; dizzi- 
ness and sleepiness ; heavy sleep, with clairvoyance and perform- 
ance of accustomed work without any recollection when awaking; 
mind absent, knows not where he is or what to answer ; dryness 
of skin, nose, mouth and throat ; flatulency ; retarded stool, or 
diarrhoea; liver troubles ; strangury after beer ; dyspnoea; chilli- 
ness. Worse from cold and damp air. 

Phosphor., great mental and physical exhaustion ; trembling of 
the limbs when trying to use them ; jerking of single muscles ; 
arms powerless, legs paralyzed ; vertigo, with loss of conscious- 
ness; indifference even towards the dearest friends; forgetfulness 
and stupidity in a measure that the patient does something else 
than what he intended; monomania de grandeur et de la richesse; 
idiocy. Inclined to diarrhceic stools and flatulency ; dry, scaly 
skin. Worse in cool and damp weather. 

Pulsat.,is a better antidote to whisky than even Nux vom. 

Selen., craving for liquor. When Sulphur seems indicated and 
does not help. 

Sulphur, very important for many complaints as its known 
symptoms of the head, stomach, intestinal canal, liver and kid- 
neys abundantly show. 

Sulph. ac, vomiting in the morning ; acidity of stomach ; burn- 
ing in oesophagus and stomach ; sour, acrid or foul eructations. 
It has been successfully used in subduing the craving for liquor 



110 BRAIN. 

by taking for two or four weeks, daily three times, from 10 to 15 
drops of Acid. Halleri, which is a mixture of one part of sulphuric 
acid with three parts of alcohol. 

Tart, em., gastric catarrh, with great uneasiness in the stomach; 
nausea and vomiting of tough, slimy and bilious matter ; watery 
diarrhoea in small quantities ; fulness of pit of stomach and ab- 
domen, with pressure as of stones; great thirst; loss of appetite, 
even disgust for any nourishment; tongue moist and whitish 
coated ; bad taste and frequent eructations. Bronchial catarrh, 
with mucous rattling, tough and difficult expectoration; op- 
pression of the chest necessitating the patient to sit up in bed. 

Opium and Morphine-Poisoning. 

The habitual use of opium has in thousands of cases been 
brought about by the criminal ignorance and recklessness of 
physicians, who know not what they are doing, when they pre- 
scribe laudanum or morphine for any and every little pain, or 
use it as hypodermic injections. The habit of opium eating has 
so alarmingly increased, that it is necessary to mention here also 
this artificially induced misery of frail human nature. It is not 
necessary to go into the details of Opium symptoms; they can 
be found in our provings. Its chronic effects may be summed 
up in the following: "General emaciation, pale, shrivelled com- 
plexion, dry skin, looking like fish-scales, relaxation of the mus- 
cles, failure of appetite, disturbed digestion; at the commence- 
ment obstinate constipation, followed later on by dysenteric diar- 
rhoea. Superadded are fanciful, discontented temper, giddiness, 
headache, sleeplessness, all possible eccentric neuralgias, failure 
of memory, understanding, energy and will; patients become 
untrustworthy and are very regardless of truth, especially when 
they are questioned about their habit; also paralysis and diseases 
of the bladder." All this is gradually produced by the direct in- 
fluence of opium upon the substance of the nerves, and it is there- 
fore in accordance with the nature of opium-action, when post- 
mortems do not show any particularly characteristic anatomical 
changes. Hypersemia of the brain is most constant ; sometimes 
an accumulation of fluid is found in the subarachnoid spaces and 
in the ventricles; sometimes, also, sanguineous effusions of greater 
or less extent in different parts of the brain. The bladder is 
generally found distended. All other anatomical conditions seem 
accidental and not due to opium-poisoning as such. 



OPIUM AND MORPHINE-POISONING — TUMORS. Ill 

THERAPEUTIC HINTS.— In acute poisonings the stomach-pump 
is a safer and surer means to remove the poison than any of the 
usual emetics, because the latter often fail to produce vomiting 
on account of the insensibility of the nerves of the stomach 
caused by opium, and also because the patient escapes by its 
application a possible gastritis, which often follows the adminis- 
tration of Tart. em. and other irritant substances. By its means 
the stomach can be washed out with green tea, coffee or sage tea, 
by which a less poisonous compound (tannate of morphine) is 
formed. In order to prevent complete narcosis it is well to 
make the patient walk about for hours, or to apply painful 
stimulation to the skin, the cold douche-bath and the like. 
After sopor lias set in, the walking about forbids itself; we 
ought, however, conduct as much fresh air to the face and head 
as possible. In this state injections of a tea of oats have been 
recommended. 

Bellad. is no doubt the best antidote against acute poisoning. 
Even the old school acknowledges it and uses hypodermic in- 
jections of Atropine. 

Chamom., when after abuse of morphine to lull pain, sleepless- 
ness ensues and the suffering grows intolerable notwithstanding. 

Ipec, only lately shown as efficient for the cure of the habit of 
opium- eating. Fifteen drops of the tincture were given at a 
time until improvement set in. 

Nux vom., often indicated in cough and diarrhoea after previous 
use of so-called cough and diarrhoea mixtures, all of which most 
generally contain opiates. 

Tumors of the Brain and its Membranes 

Consist of morbid growths in the connective and epithelial tis- 
sues of the blood-vessels and their sheaths, which either retain 
the character of the affected tissue, or become altered by modifi- 
cation of the newly-formed elements and by changes in their 
relations to the connective tissue and vascular distribution. 

Their Causes seem to be a hereditary predisposition, abuses of 
spiritual drinks, blows and falls of all kinds, syphilis and tuber- 
culosis. They occur much more frequently in men than in 
women. 

Tumors which retain the character of the affected tissue, are: 
Glioma, formed by proliferation of the neuroglia, greatly re- 



112 BRAIN. 

sembles normal brain tissue, and is therefore not easily distin- 
guishable; when it assumes a more mucous character, it is soft 
and closely resembles myxoma; when its structure is harder, it 
resembles and is allied to sarcoma. It grows slowly, may finally 
undergo fatty degeneration and is found usually in the white 
substance of the cerebral hemispheres and especially their pos- 
terior lobes. 

Hyperplasia of the pineal gland presents a solid, grayish-red, 
slightly tabulated or else smooth, round tumor, which may grow 
as large as a walnut or even larger; its histological elements are 
somewhat larger and firmer than in the normal. 

Psammona or sand tumor is an inflammatory proliferation of 
the cellular tissue in which a calcareous deposit takes place; it 
usually grows from the dura mater commonly at the base of the 
skull, is a hard, hemispherical tumor, white and smooth and of 
the size of a cherry-stone. 

Melanoma takes its origin in the pigment cells of the pia, is 
small in size, but may be multiple; is of rare occurrence. 

Neuroma, a genuine hyperplasia of the gray substance, occurs 
in sizes from a millet-seed to that of a pea and is found on the 
ventricular surface, in the white substance, or on the outer surface 
of the brain. 

Hyperplasia of the anterior half of the pituitary gland. 

Cysts may be the result from apoplectic effusions, abscesses and 
softening. 

Aneurisms are of frequent occurrence, especially upon the large 
vessels at the base of the brain, and usually in consequence of 
atheroma; when bursting they cause fatal apoplexy. 

Cholesteatomata consist partly of hardened epithelial cells and 
partly of epithelial cells which have undergone fatty degenera- 
tion; they unite, as Rindfleish says, " the structure of an epithelial 
carcinoma with the harmlessness of a wart or weal." They are 
generally found in some hollow at the base of the skull or in 
some recess of the brain. 

Tumors by which the affected tissue is changed in its char- 
acter, are: 

Tubercles, gray, yellow, or yellowish-white, hard tumors, which 
frequently grow larger than a hazel-nut ; their favorite position 
is the gray substance, especially of the cerebellum; they occur 
most frequently in childhood. Miliary tubercles are a frequent 
concomitant or source of meningeal inflammation. 






TUMORS. 113 

Carcinoma appears usually as primary fungus hgematodes on 
the outer or inner surface of the dura. When starting from the 
outer surface it rapidly softens and pierces the skull bones and 
then spreads on the external surface of the skull (fungus durae 
matris); when originating on the inner surface its growth is 
entirely directed towards the brain; it never penetrates the dura, 
except at the natural openings for the nerves, such as the olfac- 
tory, optic, etc., hence the growing in and out of cancers in the 
orbits on the perforated plate of the ethmoid bone, in the spheno- 
maxillary fossa and so on. 

Sarcoma is either a hard, dense, homogeneous mass, which can 
easily be detached from the surrounding tissue, or is of a soft, 
medullary consistence, which constitutes a transition to a myx- 
oma or glioma. 

Myxoma forms a very soft gelatinous mass, which frequently 
breaks down into cysts containing a mucous fluid; they may 
attain the size of a man's fist, and are met with only occasionally 
in the cerebral hemispheres. 

Syphilitic tumors are not common ; they generally resemble the 
gummata of other parts, being composed chiefly of greyish semi- 
translucent matter, which is liable to become opaque and crum- 
bling on undergoing a caseous transformation. 

Symptoms. — One should suppose that the pressure of any of 
these tumors should manifest itself more or less by various out- 
ward symptoms. But this is not always the case. Large tumors 
have been found post-mortem, and not a single symptom did be- 
tray them during life. It is remarkable how the system, even 
the brain, may become accustomed to an abnormal growth, when 
it is invaded slowly. Yet there are symptoms in many cases 
which should rouse our suspicion in this direction. They are : 
"Depression of spirits, melancholy, rarely maniacal attacks, men- 
tal derangement, aphasia, sleepiness ; amblyopia and amaurosis, 
with the appearance of choked disk and neuroretinitis ; inequal- 
ity of the pupils ; strabismus ; violent headache, often accurately 
localized ; monolateral anaesthesia, usually in the form of anaes- 
thesia dolorosa ; neuralgia ; monolateral paralysis of varying de- 
gree, gradually increasing ; jerking, quivering ; cramps of the 
affected groups of muscles, developing sometimes into epileptoid 
attacks." Further on : " imbecility ; total want of energy ; sopor, 
comatose condition; wide-spread anaesthesia; very hesitating 
speech ; paraplegia ; incontinentia urinae et alvi, or else reten- 



114 CRANIUM. 

tion ; increased temperature of the body ; symptoms of men- 
ingitis; apoplexy." 

Glioma is to be thought of when there is : " preceding consider- 
able injury of the skull; slow progress of the symptoms and 
hence relatively long duration of the illness ; intercurrent apo- 
plexies ; good state of nutrition." 

Tubercular tumors, when there is "a hereditary predisposition 
to tuberculosis ; occurrence in childhood ; tuberculosis of other 
organs ; commencement of the symptoms after acute febrile dis- 
eases, for instance, measles ; complication with meningitis." 

Carcinoma, when there is " a rapid progress of the symptoms ; 
perforation of the bones of the skull; carcinoma in other organs." 

Notwithstanding all this, the Diagnosis of brain tumors will 
in many cases remain problematic and is often impossible. 

THERAPEUTIC HINTS.— Little can be said. In all cases we must 
be governed by the totality of the symptoms, even if we should 
suspect a tumor. 

When a considerable injury of the skull has preceded, we will 
have to choose a remedy accordingly. 

When tubercles are suspected, compare what has been given 
under meningitis tuberculosa. 

In case of carcinoma, compare: Calc. carb. or phosph., Arsen., 
Carb. an., Bellad., Laches., Phosphor., Silica, and many others. 



DISEASES OF THE CRANIUM AND ITS INTEGUMENTS. 



a. ABNORMAL LARGENESS OF THE HEAD 

May be caused by hydrocephalus, hypertrophy of the brain and by- 
pseudo-formations within the cavity of the skull, when, they perforate 
the skull. To this are to be added morbid conditions of a more 
external nature. 



Dropsy of the Scalp. 

This is a collection of serum either in the cellular tissue (eel 
hilar dropsy) or between the aponeurosis and the pericranium (ap 



• 



HYPERTROPHY — BRUISED HEAD AFTER BIRTH. 115 

neurotic dropsy). When the watery fluid collects in the cellular 
tissue, it is apt to spread down to the face; and on pressure with 
the finger it leaves a pit ; as is seen on all parts of the body, 
where dropsical effusions exist within its cellular tissue. When 
it is underneath the aponeurosis or the galea capitis, the swelling is 
tight, elastic, fluctuating, and leaves no pit on pressure, and never 
Spreads over the ears or eyelids, and this for obvious anatomical 
reasons. 

Both forms exist without cerebral symptoms, and may be 
the consequence of either a general dropsical condition, or of 
erysipelas, external injuries, stings of insects, eruptions, and so on. 

Hypertrophy of the Skull. 

This may either involve a part only of the cranium, in which 
case it forms exostosis or bony protuberances; or the whole skull, 
whereby the bony walls may attain a thickness of one inch and 
a half. Both forms cause an enlargement of the head, and are 
mostly found as a concomitant to rhachitis or syphilis. When 
they grow from the inner plate of the skull, they do not cause an 
external enlargement of it, and are therefore not recognizable 
with any degree of certainty. 

The Bruised Head of a Child after Birth, 

Caused by the pressure during birth, is either an extravasation of 
lymph or blood into the cellular tissue; in which case it is called 
caput succedaneum ; or it is an extravasation of blood between the 
bones and the pericranium, causing the affection called thrombus 
neonatorum. 

The Caput succedaneum may extend over the fontanels or sutures 
of the bones; it may even be formed on any part of the head suf- 
ficiently exposed to a great pressure of the pelvis, or the forceps, 
during labor. It has a soft, doughy feel, and the outer skin looks 
bruised. 

The Thrombus, however, is confined generally to the parietal 
bones, and never extends over the sutures of the bones, because 
there the pericranium adheres firmly to the skull. It feels elastic 
and fluctuates, and shows no discoloration of the external skin. 

Both forms are in their nature bruises, and ought to be treated 
should treatment be necessary at all, like bruises. Arnica will 



116 CRANIUM. 

usually do what is required; in some cases, however, Bar. mur. 
and Mercur. have been successfully applied. 



b. ABNORMAL SMALLNESS 

Of the head is found in idiots. It may be partial or general, 
congenital, or caused after birth, before ossification is completed. 
Always, however, it will be found in connection with an imper- 
fect development or derangement of the brain. 



c. AFFECTIONS OF THE SKULL WITHOUT EN- 
LARGEMENT. 

The cranium consists of two tables, which run parallel with 
each other, and are separated by an intermediate cellular struct- 
ure, which is called diploe. The whole, however, consists of 
eight different bones, which are connected to each other by sut- 
ures. Before these sutures consolidate, there are, of course, on 
those places where different bones are to meet, larger or smaller 
openings, which are called fontanels. At the time of birth, how- 
ever, as a general thing, only one of these fontanels exist, and 
that is the anterior opening, whilst the posterior and parietal open- 
ings have already closed. 

The anterior fontanel closes normally in the second year of life. 
If it stays open much longer than two years, it shows a want of 
proper nutritive action in the system ; if it grows larger, dividing 
the frontal bone and parting the parietal bones, it is a sign of 
chronic hydrocephalus, or of hypertrophy of the brain. If you 
lay your hand softly upon it, or watch it closely, you will observe 
a constant motion up and down, a kind of breathing of the brain. 
Screaming or coughing causes momentary distention and protru- 
sion of the integument over it. If, however, as in cases of men- 
ingitis, this opening swells out permanently, it is a sign of exudation 
of serum in the brain. Its suddenly sinking in denotes a collapse 
of the brain, which is soon followed by death. In like manner, 
the posterior fontanel, by a morbid process of absorption of the 
already-formed bony substances, may reopen; or several holes 
may form near by — the bony structure withering away gradu- 
ally, leaving only the integuments. This is called the Soft occiput 
or Craniotabes. It has been observed mostlv towards the end of 



ATROPHY OF THE SKULL. 117 

the first year, especially in children of rhachitic or scrofulous 
parents. It is doubtless a deep-seated, constitutional disorder, 
and can be successfully treated only by a careful study of all the 
symptoms. Nevertheless, Sulphur, Calc. carb., Calc. phosph. and 
Silic. might often be indicated. If not checked, it frequently be- 
comes complicated with meningitis, or pneumonia, or tubercu- 
culosis and diarrhoea, which soon end the scene. 
To this I may add — 

Atrophy of the Skull. 

This may be a consequence of internal pressure from carci- 
noma within the cavity of the skull, which may even perforate 
the cranium ; or from hypertrophy of the brain ; all of which have 
already been mentioned. 

We also meet with inflammation of the skull or ostitis, with all 
its sequela? — caries and necrosis — which is mostly of a syphilitic 
or tuberculous origin, or is caused by external wounds badly 
treated. 

THERAPEUTIC HINTS.— Caries call for Asaf., Calc. carb., Calc. 
phosph., Fluor, ac, Pulsat, Silic, Sulphur, and other remedies. 

d. DISEASES OF THE INTEGUMENTS. 

The integuments of the cranium consist of the following five 
different layers : 

1. The external shin or derma is covered thickly with hair, 
and contains innumerable sebaceous and sudoriparous glands, of 
which the former secrete an oily, fatty substance, and the latter 
are the organs of perspiration. 

2. Tlie subcutaneous cellular tissue, in which the net-work of the 
larger blood-vessels and nerves lies imbedded, and which con- 
joins the derma to 

3. The aponeurosis; which is expanded tightly over the cra- 
nium Under it is found — 

4. The second cellular tissue, which consists of loose mashes 
and connects the aponeurosis only loosely with 

5. The pericranium, which is the immediate covering of the 
bones, and which, although very thin, is nevertheless of great 
strength. It transmits numerous blood-vessels into the bones. 



118 SCALP. 

In diseases of the scalp, all or single of these different layers 
may be affected. 

Erysipelas of the Scalp and Face. 

Erysipelas is an acute febrile disease, characterized by a pe- 
culiar inflammation of the skin and enlargement of the neigh- 
boring lymph-glands, which is accompanied by more or less 
severe general symptoms. It is contagious and inoculable, and 
arises spontaneously under conditions not accurately determined ; 
in the latter case it is called Idiopathic. When spreading by its 
own contagion which diffuses itself through the air or is carried 
by linen or instruments previously used for dressing patients 
with erysipelas, or by flies — it is called Traumatic, and is mostly 
found in the surgical wards of hospitals. As the slighest scratch 
may be the recipient of the poison, the disease is often communi- 
cated to nurses and physicians. Recent writers on this subject 
do not make any distinction between these two forms, and assert 
that the idiopathic form also arises from some insignificant 
injury, which only could not be discovered! This is driving 
the desire for simplification rather too far. There are a num- 
ber of cases especially on face and scalp which arise without 
any scratch or wound, and under conditions where infection is 
entirely out of question. In fact the whole complex of symp- 
toms shows that it is not a local but a constitutional disease in 
no less degree than measles, scarlatina and other febrile diseases. 
Da Costa in an excellent treatise on the internal complications 
of acute erysipelas (American Journal of the Medical Sciences, Oct., 
1877, p. 321, etc.) admits as much, and also prints a whole series of 
cases observed by himself, in which he found that the idiopathic 
form was almost invariably attended by albuminuria, which in 
the traumatic form was either entirely absent or present only in 
a decidedly less marked degree. Hahnemann considered ery- 
sipelas as one of the acute outbursts of a psoric taint. He was 
probably correct even in this. "Erysipelas, like phlegmonous 
inflammation, affects the skin in its whole thickness and the sub- 
cutaneous cellular tissue. All the layers of the corium and of 
the subcutaneous cellular tissue are cedematous, swollen, and 
penetrated by large, finely granulated, white blood-corpuscles. 
The meshes of the connective tissue in which these cells are em- 
bedded are very dedidedly separated by them and by the fluid 






ERYSIPELAS. 119 

which uniformly permeates the tissues. The most important 
distinctive feature of erysipelas is its disposition to spread only 
by creeping uninterruptedly onwards without making jumps," 
or as Billroth has it, "it spreads like water in blotting paper." 
"When on the scalp or face it is limited mostly to a more or less 
extensive portion of the skin of the head and face and seldom 
descends over the neck to the trunk ; on other parts of the body 
it is apt to spread over larger surfaces. 

Its local Symptoms are frequently preceded a day or two by a 
feeling of general malaise, chilliness and feverishness. Then the 
part affected begins to feel hot and tense; the skin reddens and 
swells, and becomes very sensitive to the touch. At the same 
time the adjacent lymphatic glands commence to swell. The in- 
flamed portion assumes a red, smooth and shiny appearance, 
which is, however, darker and duller on the scalp than on other 
parts, and to the touch it gives the impression of a hard, stiff, 
caked mass. The inflammation gradually creeps on until it 
reaches from side to side of the scalp, down into the face, and 
even to the neck and shoulders. 

On the second or third day, generally, the redness and swell- 
ing reach their height, and, at this stage, in some cases, the epi- 
dermis becomes raised and filled with a yellowish, limpid fluid, 
sometimes tinged with blood, in the shape of large blisters — 
Erysipelas buUosnm — which either dry up, or burst and become 
covered with crusts. 

During the height of the disease, the patient has high fever, 
with evening aggravations ; his sleep is restless and full of dreams ; 
he sometimes becomes delirious. On the fourth day the red- 
ness and swelling gradually subside on the places first attacked; 
while those parts which were invaded later stand yet in full 
bloom. By-and-by, however, they grow paler, softer, and assume 
a wrinkled appearance, as the swelling leaves; the crusts dry off, 
and on the whole surface the epidermis peals off in large flakes; 
the entire process lasting from about eight days to two weeks. 

But this is not invariably its course. Just in its very nature, 
to creep on, lies its danger. It may, by continuity of tissue, 
wander to the mucous membrane of the nasal and pharyngeal 
cavities, cause an oedema of the glottis, and affect the larynx, 
the bronchial tubes, and even produce pneumonia and pleuro- 
pericarditis. 

An extension of erysipelas to the meninges (erysipelatous men- 



120 SCALP. 

ingitis), or to the brain tissue (cerebritis) which, on account of 
the violent brain symptoms, in former days was supposed to be 
the cause of death in many cases, has by later observers not been 
found, even though numerous post-mortems of typical cases have 
been instituted in search for it. Da Costa found only " some ful- 
ness of the vessels of the membranes, a kind of venous tur- 
gescence, yet not extreme," but no sign of any kind of inflamma- 
tion. An explanation of the violent brain symptoms has been 
variously tried — the assumption of blood-poisoning, as in other 
exanthematic fevers, is probably the most rational. 

The tongue usually is covered with a white creamy coat, which 
dries gradually, becomes dirty yellow and, when the fever is pro- 
tracted, blackish and crust-like ; there is nausea and vomiting ; 
sometimes diarrhoea and, what seems very remarkable, in rare 
cases profuse intestinal haemorrhage, in consequence of ulcers in 
the duodenum, which generally have proved fatal, and remind 
one of similar symptoms which are occasionally observed after 
severe burns of the skin. In almost all idiopathic cases there is 
albuminuria. The fever, accompanying erysipelas, is character- 
ized by a sudden rise of the temperature to even 104° F. or 
higher often within from 8 to 12 hours, still rising to 105.8° and 
in some cases to 107.6° F. Exceptionally, however, the tempera- 
ture shows periods, even for the length of a whole day, of marked 
depression, after which again a sudden rise takes place. When re- 
covery approaches, it usually sinks as rapidly as it rose, and may 
attain its normal standard within a few hours or in a single 
night ; then desquamation of the epidermis, in the form of large 
or branny scales, and wrinkling of the skin terminate the local 
process. However, even after this in some cases a renewed sud- 
den rise of temperature has been observed. The hair usually 
falls out, but quickly grows again. The skin too recovers its 
normal state; only upon the eyelids, the scrotum, the prepuce 
and vulva, where it is naturally tender, it may in severe cases 
undergo a more or less extensive gangrenous destruction, and its 
duration be prolonged to several weeks, even months. 

Unlike to other infectious fevers, erysipelas leaves a very great 
susceptibility for renewed attacks. Not a few persons are subject 
to a periodically returning form — the so-called Habitual erysipelas, 
which mostly affects the face or lower extremities. 

The nature of its contagium is not all known ; it seems, how- 
ever, to possess great tenacity. 



ERYSIPELAS. 121 

The Prognosis of erysipelas is favorable, as long as it does not 
spread to internal organs. 

THERAPEUTIC HINTS.— The external application of raw cot- 
ton to the inflamed parts, to keep off the air, as in burns, I have 
found decidedly beneficial. The terrible itching is sometimes 
alleviated by the application of rye-flour. 

Apis, spreading down to the face with great cedematous swell- 
ing of the eyelids, forming reddish, watery bags under the eyes ; 
stinging, pricking, burning ; smooth or blistered ; thirst or no 
thirst. 

Bellad., especially right side; eruption smooth, shining, streaked, 
of bright red color ; brain symptoms prominent ; sometimes 
nausea, gagging, wretching; or coughing; drowsy but cannot 



Borax, mild form ; left side ; painful when laughing with sen- 
sation as if covered by cobwebs. (Bonninghausen.) Pale, red 
cedematous swelling from left lower eyelid down to cheek ; anx- 
iousness; childbed; after Apis and Rhus tox. had failed. (Fellger.) 

Euphorb., highly prized by Dr. H. Boskowitz. It helped after 
Graphit. had failed. (W. E. Payne.) 

Hydrast, wandering from left side of nose to right over whole 
face and scalp ; intense pain in the lumbar region ; chills down 
the back; extremely restless; disturbed by noise; delirium; 
urine suppressed. 

Laches., purplish, leaden hue ; tongue dry, glossy, tremulous ; 
visions, and delirious talk as soon as he shuts his eyes ; aggrava- 
tion from noon till midnight. 

Pulsat, the ears are especially affected; during damp, wet 
weather. 

Rhus tox., vesicular form; spreading from left to right; burn- 
ing and itching ; nasal and pharyngeal cavities inflamed ; great 
restlessness ; pain in back and limbs, worse in rest ; after getting 
wet. 

Ver. vir., right side of head and face much swollen and cov- 
ered with large blisters ; headache ; high fever ; no sleep ; no 
appetite ; intermitting attacks of nausea ; occasional vomiting of 
the water drank. It was applied low, externally and internally. 
Still other remedies may be indicated. 

Arsen., irregular progress; disposition to internal organs; 
terrible restlessness and sinking of strength ; fainting ; pain in 



122 SCALP. 

the bowels and haemorrhage, as sometimes occurs m large 
burns. 

Camphor., great exhaustion ; coldness of skin ; breathing scarcely 
audible or visible. Bb'nninghausen has recommended it for the 
initial symptoms, low and frequently repeated. 

Canthar, large blisters, irritable and burning; after Rhus tox. 
had failed. Post-erysipelitic chronic prickling of the skin. 

Chamom., suppuration of the cellular tissue; low externally and 
internally. 

Crot. tigl., cedematous swelling of eyelids; large and small 
blisters; intermediate skin cracked and peeling off; violent 
burning. 

Cuprum, sudden sinking of the swelling and changing into a 
bluish color ; violent brain-symptoms. 

Graphit, tendency to repeated attacks of erysipelas bullosum; 
also when new aggravations come on during the same attack ; 
constrictive headache in occiput; perspiration does not relieve. 
Habitual erysipelas, often alternating with tettery eruptions. 

Ipec, retrocession of eruption, with vomiting. 

Kali carb., from right to left side; cedematous swelling under 
the eyebrows. When touched ever so slightly on his feet, he 
jerks them up much frightened; he talks of pigeons flying in the 
room, which he tries to catch with his hands; he gets regularly 
worse about 3 o'clock a.m. After previous attacks. 

Sulphur, psoric taint ; helps often when all others fail ; habitual 
form. 

Phosph. ac, traumatic form, where the periosteum is affected. 

Ruta, in combination with wounds. 

Silic, when the bones are injured. 

Gangrenous destruction, hints to : Arsen., Carb. veg., Cinchon. 
and Sec. cor. 

Schussler recommends Natr. sulph. for the smooth form with 
or without vomiting of bile, and Kali mim for erysipelas bullosum. 

Eczema Capitis, Humid Tetter or Scald. 

"A non-contagious affection, characterized by the eruption of 
minute vesicles in great numbers, and frequently confluent, 
upon a surface of irregular form and usually of considerable ex- 
tent. The vesicles are so closely aggregated in some situations 
as to give rise to one continuous vesicle of great breath." (Wilson.) 

They dry and form thin scales, or else break and discharge a 



ECZEMA — IMPETIGO. 123 

watery or milky fluid of different consistencies, which, hy con- 
creting, give rise to thinner or thicker crusts. It is acute and 
chronic in its nature, and may appear on any part of the body. 
According to its appearance, location, or severity and obstinacy, 
it has received a variety of names, which gives a nomenclature 
most remarkably confused and confounding. It is called ekthema, 
porrigo, tinea with various adjectives, and, if chronic, psoriasis. 
In order to simplify the whole, we will just remember, that 
eczema exhibits the following characteristics : It is a vesicular erup- 
tion, in clusters, often confluent, discliarging limpid or turbid and 
milky fluid, ivhich forms crusts of different thickness, is acute or 
chronic, mild or severe, situated here or there. 
It may be confounded with 

Impetigo, 

Because its appearance so closely resembles this latter as to force 
upon the mind the impression that they are the same disease. 
And, indeed, impetigo, derived from ab impetu — a bursting forth 
with violence — is nothing but a pushdar eczema; so that, in order 
to distinguish between the two, we must know what is a vesicle 
and what is a pustule. By vesicle is understood a very small blis- 
ter, containing a transparent, limpid fluid; a pustule means a 
pimple, containing pus. The difference between eczema and im- 
petigo lies then in the pyogcnetic (that is, pus-forming) character 
of the latter. If both are found together, covering large patches 
on the scalp, their distinction is quite difficult, unless we say: 
the hardened coverings of the excoriations of eczema are thin scabs, 
because growing out of a limpid, thin fluid — lymph; while those 
of impetigo are tense and thick, greenish-yellow, or brownish crusts, on 
account of their being formed from pus. 

THERAPEUTIC HINTS.— Calcar., Lycop., when the eruption yields 
a thick and mild secretion. 

Arsen., Natr. mur., Rhus tox., when it looks angry, excoriated. 

Baryt. carb., Graphit, Natr. mur., Rhus tox., when it causes falling 
out of the hair. 

Lycop., Psorin., when it smells very badly and causes lice. 

Natr. mur., when situated on the boundaries of the hair on the 
nape of the neck. 

Clemat., Petrol., when on the neck and occiput. 



124 SCALP. 

Hepar sulph, when the eruption itches worse in the morning, 
when rising, with burning and smarting after scratching — like- 
wise after external application of salves. 

Clemat, Graphit., Hepar sulph., Lycop., Natr. mur., Rhus tox., Staphis., 
Thuya, for moist eruptions. 

Arsen., Calcar., Mercur., Sepia, Silic, Sulphur, far dry crusts. 

Mercur., when the lymphatic glands are inflamed. 

Baryt. carb., when the lymphatic glands are swollen and painless. 

Arseu., nightly burning and itching, relieved from external 
warmth. 

Baryt. carb., falling off of the hair; glandular swelling on the 
neck and under the lower jaw. 

Bromium, eruption covering the scalp like a cap; oozing pro- 
fusely and smelling badly; cervical glands swollen. 

Calc. carb., during teething; scrofulous habit, swollen glands of 
the neck ; burning worse after washing ; small wounds suppurate 
easily; sweat after eating or drinking anything warm; worse 
about new moon. 

Cicuta, tbick yellow crusts. 

Clemat, the eruption looks angry and inflamed during the in- 
creasing, and is dry during the decreasing moon. 

Crot. tigl., vesicles and erysipelatous inflammation around the 
crusts ; itching, and burning after scratching. 

Graphit, eruption with sticky secretion ; causing falling out of 
the hair; commencing behind the ears and spreading over the 
scalp and face, especially on chin; chronic lachrymation ; fluor 
albus; worse after washing. 

Hepar, especially back part of head: itching; worse in the 
morning; falling out of hair and leaving bald spots; crusts dry 
on some and moist on other places with inflamed surface and 
pus underneath; hard, knotty pimples like small furuncles in 
the face and other parts of the body; scrofulous ophthalmia; en- 
larged glands on nape of neck ; frequent urging to stool and dif- 
ficult discharge ; sour smelling sweat at nights. 

Hydrastis, especially on margin of hair in front; oozing after 
washing; all secretions tenacious, ropy and profuse. 

Lycop., crusts with lice between the crevices : underneath oozing 
of bloody or purulent fluid; badly smelling; sore and moist 
behind the ears; often eruptions on other parts of the body. 
Skin dry, raw, chapped and cracked ; disturbed sleep with 
sudden loud screams ; emaciation. 



! 



DANDRUFF. 



125 



Mercur., stinging and burning; surroundings inflame after 
scratching ; salivation and sore gums. 

Mezer., eruption dry and scaly, extending over forehead, ears 
and neck ; or thick leathery crusts with pus underneath, matting 
the hair, and breeding vermin ; violent itching, worse in bed 
and from touch. 

Natr. mur., raw surface ; the discharge is corroding, eating away 
the hair, without forming thick crusts. Especially on the boun- 
dary of the hair on the nape of the neck. 

Petrol, crusts on scalp; soreness behind the ears; tetter on 
nape of neck, breast and knees ; chapped skin ; hands and fingers 
full of bloody rhagades during winter. 

Psorin., badly smelling, yellowish, moist crust with lice ; terri- 
ble itching ; sadness ; don't want the head uncovered ; the whole 
body has a filthy smell, even after bathing. 

Rhus tox., often indicated ; the crusts are thick with greenish, 
fetid pus underneath and fresh pimples on the surroundings; 
stiffness of neck and swollen glands on nape of neck and axillae ; 
itching worse at night. 

Staphis., crusts are moist, offensive, and itch violently; on 
scratching the itching is relieved, but appears immediately at 
some other place. 

Sulphur, dry or moist crusts; eruptions, pimples on different 
places of the body; eyes inflamed with photophobia ; face bloated, 
pale ; cervical glands swollen ; stool undigested, diarrhoea early 
in the morning; belly bloated: sleepless nights on account of 
itching ; easily bleeding after scratching. 

Viola trie. (Jacea), thick crusts and oozing of profuse yellow 
fluid, matting the hair together ; frequent involuntary urination ; 
the urine smells like cat's urine. 

Dandruff 

Is an eczema with but scanty exudation, not sufficient to raise 
the epidermis into vesicles; it merely loosens it, when it dries 
and peals off in scales. The scalp underneath remains congested, 
and thus new scales are constantly reproduced. It may extend 
over the whole scalp even down to the eyebrows, the whiskers 
and the beard, or be confined to patches only of irregular form 
and variable dimensions. The most effective remedies against 
small, brany scales are according to Jahr: Bryon., Sulphur, Calc. 



126 SCALP. 

carb., Kali carb., Arsen., Alumin. For the pealing off of large 

scales, the same author recommends: Phosphor., Lycop., Sulphur, 
Calc. carb., Nitr. ac. 



Seborrhea Capillittii. 

"The secretion of the sebaceous glands in the foetus is greater 
during intra-uterine life than subsequently, and we meet it at 
birth on the body generally, where it constitutes the vernix 
caseosa. This abundant secretion continues on the scalp during 
the first year of extra-uterine life, and if the sebum is allowed to 
collect there and gather dirt and dust from without, we may have 
finally crusts several lines in thickness, and the whole hairy 
scalp may be enveloped in a thick layer of sebum. When the 
crusts remain for a long time, the seborrhcea is generally compli- 
cated with eczema, for the collected mass of sebum decomposes, 
macerates and irritates the skin, and produces redness and moist- 
ure on it. The same disease appears also as thick scales, which 
cause the hair to adhere to one another in little bundles (psoriasis 
amianthacea). In adults it forms one of the commonest varieties 
of scurf, or dry scales, which are formed in large quantities, and 
in old people it is seen in connection with senile decay. The 
scalp is for the most part devoid of hair, and covered with a dirty, 
yellowish-brown, easily removable crust. It may also be a part 
of syphilis." (Lilienthal's Skin Diseases, p. 118.) 

THERAPEUTIC HINTS.— These crusts are best dissolved by the 
application of oil or grease, and afterwards removed by washing 
with castile soap. The internal use of Sulphur, a dose of a high 
potency occasionally, corrects the disposition for this abundant 
secretion. For adults Phosphor., Calc. carb., Natr. mur., Graphii, 
Viuca min., Mercur., have been recommended. 

Favus, Honey-comb Ringworm, Tinea favosa or Maligna, 
Porrigo favosa or lupinosa, 

Is a vegetable parasite, the achorion Schoenleinii. " It used to 
be classed among the pustular eruptions, because it first appears 
as a small yellow spot, the sheath of the hair being filled with 
the fungous growth ; but it has no tendency to suppurate. It 
grows with great rapidity, and forms large, hard, dry crusts, 



FAVUS, ETC. 127 

which have a peculiar mouse-like odor. It is most liahle to he 
confounded with impetigo, hut it requires only moderate care to 
determine whether the crust be hardened pus or an independent 
growth. The distinction is based upon the presence or absence of 
secretion; be the crust of impetigo ever so dry, some trace of 
purulent secretion is sure to be met with ; and if removed by a 
poultice, the moist, exuding surface cannot be mistaken. Know- 
ing this fact, we have no need to particularize the rounded form, 
the cracked, broken-looking surface, and all the other characters 
resembling honey-comb, which the older writers were obliged to 
enumerate." (Barcley.) The scalp is its most usual place of de- 
velopment, but it is sometimes found upon the nape of the neck, 
or in front of the ear, and even upon the arms. 

" The pathology of favus is best understood by considering it 
essentially to be a form of abnormal nutrition, with exudation of 
a matter analogous to, if not identical with, that of tubercle, 
which constitutes a soil for the germination of cryptogamic 
plants, the presence of which is the pathognomic of the disease. 
Hence is explained the frequency of its occurrence in scrofulous 
persons, among cachectic or ill-fed children, and the impossibil- 
ity of incubating the disease in healthy tissues, or the necessity 
of there being scaly, postular and vesicular eruptions on the in- 
teguments previous to contagion." (Bennet, Lilienthal's Skin 
Diseases.) This view is born out by actual clinical experience. 

Jahr says: "Notwithstanding its parasitic nature it has been 
cured by the sole internal administration of Sulphur, Calc. carb., 
Rhus tox., and Arsen., and Teste considers the treatment of this 
affection the triumph of Homoeopathy, recommending: 

Sulphur and Dulcam. for the humid form in children of blonde 
and fresh complexion. 

Viol, trie, in alternation with either of the above when the itch- 
ing is very violent. 

Oleand., when there is intense itching and an insupportable 
nocturnal burning after scratching; affection of the mesenteric 
glands with swelling, hardness and tension of the abdomen, and 
frequently loose and undigested stools. 

Hepar sulph., when extending to the nape of the neck or the 
face ; ophthalmia with or without ulceration of the cornea, etc. 

Besides compare Arsen., Baryt. carb., Bromine, Calc. carb., Dulcam., 
Graphit, Hepar., Mercur., Mezer., Rhus tox., Petrol, Staphis., Sulphur, 
Viol, trie, under Tinea capitis. 



128 SCALP. 

Lapp, maj., grayish-white crust over head, face and neck ; swell- 
ing and suppuration of the axillary glands. 

Phosphor., the skin of the denuded scalp is clear, white and 
smooth. 

Vine, min., spots on head, oozing, matting the hair together; the 
hair falls out in single spots, while hair grows on it. 

Tinea, Herpes tonsurans, or Ringworm of the Scalp. 

The hair falls out in a patch of a circular form, leaving the 
skin of the head perfectly smooth. It is a microscopic fungus, 
known as trichophytum tonsurans, that invests the roots of the 
hair and destroys them. 

Cases are reported as having been cured by Graphit, Phosphor., 
Arsen., Tellur., Sepia, and others. Alcohol is said to destroy the 
parasite. 

The Wen 

Is an encysted tumor of varying size ; from that of a small pea 
to the size of a walnut, and even a small orange. 

" The sebaceous or fatty substance in these sacs or c} 7 sts is va- 
riously altered in its qualities and appearance. Sometimes it is a 
lympid fluid-like serum, and contains crystals of stearine; at other 
times it is soft and white, of a pappy consistency; again, it is yel- 
lowish, and resembles beeswax. Sometimes it contains epidermal 
scales and hairs. Sometimes the contents of the cyst are exceed- 
ingly fetid ; and the fetor is increased when the tumor inflames." 
(Wilson). Under the pressure of the finger they feel elastic, and 
are movable under the skin. 

THERAPEUTIC HINTS.— Thus far have been successfully applied : 
Baryt. carb., Bellad., Calc. carb., Caustic, Clematis, Phytol., Silic, 
Sulphur, Thuja. 

The Teleangiectasia, or Vascular Nsevus, Mother's Mark, 

Is a dilatation of a portion of that fine net-work of capillary ves- 
sels which everywhere pervade the derma, and cellular tissue. 
Such dilatations may occur in either of them. They form red, 
easily compressible, flat tumors, of different sizes. They are some 
times stationary, but more frequently increase slowly in size 






THE HAIR. 129 

and we often find enlarged blood-vessels in their vicinity. They 
generally appear on the scalp, and still oftener on the forehead, 
but also on other parts of the body. 

THERAPEUTIC HINTS.— Condur., Fluor, ac, Strontian, Sulphur, 
Silic., Thuja. Phosphor., when they bleed easily. 

The Hair. 

Alopecia — its falling off — may originate in various conditions. 
If it consists in a total atrophy of the hair-follicles, the hair of 
course will never grow again; if it is only a partial atrophy, the 
hair grows thin. A transient deficiency in the nutrition of the 
hair-follicles, as it occurs in several illnesses, such as typhoid 
fever, pneumonia, puerperal fever, chronic headaches, syphilis, 
does not hinder the hair from growing again, as soon as these dis- 
turbances have passed away. 

The Alopecia circumscripta or Porrigo devalcans has its cause in a 
parasite, the microsporon audonini, which attacks the hair in 
isolated patches, and the denuded spots are left clean and polished 
and of a marble whiteness; it is not considered as contagious. 

Alopecia in consequence of erysipelas, seborrhoea and different 
eruptions of the scalp, disappears after these disturbances are 
healed. 

Cosmetic means also may bring on alopecia. 

Baldness is more or less an attribute of old age; it is found 
oftener in men, than in women; it also is seen in younger 
individuals in consequence of hereditary disposition. 

THERAPEUTIC HINTS.— Kali carb., Natr. mur., with great dryness 
of the hair. Carb. veg. after Kali carb. 

Hepar sulph., Phosphor., Sepia, Silic, after chronic headaches. 

Kali carb., Nitr. ac, after nervous fevers. 

Phosph. ac, after great anxiety and grief. 

Besides these compare Ambra, Amm. carb., Baryt. carb., 
Calc. carb., Conium, Fluor, ac, Graphit., Lycop., Natr. mur., 
Sulphur, Zincum. 

For bald patches : Aloes, Arsen., Phosphor., Vinca minor. 

The cutting of the hair is often attended with great effect upon 
the general system. Colds in the head are a very frequent conse- 
quence, and in children even spasms may result therefrom. But 
9 



130 SCALP. 

there are also cases on record where it proved beneficial to 
patients, relieving them of headache, and in one case even from 
a sort of mania. 

The changing of color into gray and white is usually a process of 
age; but grief, sorrow, and worriment may bring it on much 
before its time, and sometimes in a very short time. There are a 
number of cases related where this change took place during one 
night in consequence of terror, or other violent emotions of the 
mind, so that the poet says : " nox ! quam longa es, qua? facis 
una senem!" But of late, these instances have been doubted, 
because they are not well authenticated. However that may be, 
so much is certain, that strong mental emotions have a great 
effect upon the discoloration of the hair. 

THERAPEUTIC HINTS.— Bad consequences of cutting the hair 
are mostly removed by Bellad. or Bryon. 

The process of growing gray and white we best leave undis- 
turbed, unless we choose remedies for its next causes. All of the 
so-called cosmetic means are hurtful, sometimes dangerous ; and 
the vain will be punished for his vanity. 

The Plica polonica— matted hair— as is here and there found in 
Poland, is, according to Hebra, an eczema of the scalp, forming 
crusts, and matting the hair together in a most hideous manner. 



EYES. 



Considering the eye as a whole, we find its general appearance 
frequently altered by disease. Without dwelling upon the lan- 
guage which the mental emotions — bright, terror, joy or sorrow, 
love or hatred — speak through them, we observe: 

An unnatural lustre of the eyes in fevers; and 

A brilliancy in consumptives. 

Glassy eyes are characteristic, in children, of inflammation of 
the mesenteric glands; and, if accompanied with dark, dry lips 
and tongue, dry skin, and great restlessness, of an acute inflam- 
mation of the stomach. In fevers they indicate great danger, or 
critical changes. 

Dull eyes are frequently observed in febrile conditions of the 
system; during catamenia, in catarrhal and other affections. 

Sunken eyes are the consequence of an absorption of the fat 
cushions, whereupon the eyeballs rest and turn in their sockets. 
This takes place in all diseases which are accompanied with 
great loss of blood or other vital fluids. 

Exophthalmus or protruding eyes, when not congenital, is a 
characteristic sign of Basedow's disease. 

In treating the particular diseases of the eye, I shall condense 
in a small space what is important for the general practitioner 
in his daily practice ; the specialist will necessarily have to con- 
sult special works on this subject. 

LIDS AND LACHRYMAL APPARATUS. 

Inflammation of the Eyelids. 

It may be of various character. A simple inflammation may be 
the consequence of a cold. It usually commences on the edge 
and thence spreads over the whole lid to the margo orbitalis, 



132 LIDS AND LACHRYMAL APPARATUS. 

where it abruptly ceases. By this it is distinguished from ery- 
sipelas, which is apt to diffuse itself further and further. The lid 
is hard, swollen, and red, sometimes covered with little blisters. 

A graver form is the Phlegmonous inflammation, or Abscess of lid. 
Commencing as a little, firm nodule, it often extends over the 
eyebrow and cheek, and the lid may attain the size of a pigeon's 
egg. If not checked in the onset, it terminates in the formation 
of an abscess which breaks either outside or, in rarer instances, 
perforates the conjunctiva. If this abscess forms at the inner 
angle of the eye, near the lachrymal sac, it has been termed 
Anchylops. The Causes are : injuries (wounds or blows upon the 
eye); severe conjunctivitis, or erysipelas; spontaneous develop- 
ment has also been observed. 

A third form is the Tinea tarsi, Ophthalmia tarsi, or Blepharitis 
marginalis, etc., which consists of an inflammation of the edges of 
the eyelids. In its simplest form it shows merely a slight redness 
of the edges and some gluing together of the lids in the morning. 
This may increase, however, to ulceration, thickening and hard- 
ening of the whole margin of the lids, when it is termed Tylosis. 
The conjunctiva and the Meibomian glands usually participate 
more or less in this inflammation and if the ulceration extends to 
the hair-follicles, the lashes loosen and fall out. In places where 
the destruction is not too extensive, the lashes grow again, but thin- 
ner, crooked and often inverted, which state is called Trichiasis ; 
or there forms a double row of cilia either along the greater por- 
tion of the lid, or chiefly at one point; this is called Disticniasis. 
This faulty position of the cilia is generally accompanied, or soon 
followed, by a certain degree of inversion of the eyelid, and per- 
haps by a shortening and incurvation of the tarsal cartilage, 
which state is termed Entropium, though in simple trichiasis or 
distichiasis it is not always present. "Entropium may also resul 
from spasmodic contraction of the orbicularis muscle, especially 
in elderly persons, where the skin of the eyelids is abundant an 
lax." (G. S. Norton). When, however, by extensive ulceration o 
the edges and consequent cicatrization the apertures of the Mei 
bomian follicles become closed and obliterated, the lid's maig: 
thickens, and shows a tendency to become everted. This grow: 
the more apparent, when the conjunctiva also is involved in the 
inflammatory process. And, if to all this a certain degree of 
atrophy and relaxation of the orbicularis associates, the some 
what everted lid no longer covers the eyeball, but sinks aw 






INFLAMMATION OF THE EYELIDS. 133 

from it and the punctum lachrymale becomes exposed. This 
state of tilings is termed Eetropium. "Ectropium may also result 
from paralysis of the facial nerves, tumors, caries of the orbit, 
etc., but the most frequent cause is from cicatrices in the vicinity 
of the lids." (G. S. Norton.) 

Blepharitis marginalis occurs often as a consequence of hyper- 
metropia or myopia, but very frequently it is associated either 
with, or caused by, conjunctivitis or corneitis, affections of the 
lachrymal canal, as stricture, blennorrhcea, etc. Its intensity is 
much aggravated by dirt and want, by exposure to wind, cold, 
bright glare, or an impure, smoky atmosphere. 

THERAPEUTIC HINTS.— Simple inflammation of the lids is easily 
arrested by : 

Aeon., after exposure to cold winds. 

Apis, with cedematous swelling and stinging pain. 

Bellad., bright, shining redness ; right side ; photophobia. 

Chamom., red swelling after a cold. 

Pulsat., with catarrh in the head. 

Rhus tox., from left to right ; dull redness ; watery vesicles. 

Phlegmonous inflammation requires besides one or the other of 
the above : 

Hepar, pricking and throbbing pain, worse from cold and con- 
tact; anchylops. 

Laches., purplish hue. 

Merc, sol., pain worse at night. 

Pulsat, anchylops. 

Silic, after Hepar, when suppuration has taken place, and the 
patient wants to have his head wrapped up. 

Blepharitis marginalis is often very obstinate and difficult to 
treat. When caused by hypermetropia or myopia, suitable eye- 
glasses are the remedy ; when caused by dirt and want, their re- 
moval ought to be attended to ; washing and cleaning the lids 
with luke-warm water is a daily requirement. Remedial agents 
are quite as necessary. 

Alum., dryness of lids, worse in the morning; absence of lachry- 
mation. 

Arsen., burning, acrid lachrymation, excoriating the lids and 
cheek. 

Calc. carb. and jod., lids swollen and hard, indurated, also after 
stj'es ; tonsils enlarged. 



134 LIDS AND LACHRYMAL APPARATUS. 

Carb. ac, when caused by parasitic fungi, embedded around the 
hair follicles. 

Cinnab., discharge in the morning; dull pain from the inner 
canthus over the eye, or around it. 

Caustic, better in the open air ; warts on the eyebrows, upper 
lid or nose. 

Digit, lid-margin slightly swollen and pale red; inside of lids 
yellowish-ved ; burning of the lid-margin ; photophobia ; lachry- 
mation and mucous discharge. 

Euphras., suppurating lid-margins ; constant winking of lids ; 
profuse, acrid, burning lachrymation, or very acrid, thick or 
yellow discharge, excoriating lid and cheek; fluent coryza, which 
is mild. 

Graphii, dry crusts on the cilia?, and scales on the margins : 
the outer canthi are often the most affected part; they crack and 
bleed easily ; moist eczema on the head and behind the ears, 
cracking and bleeding. "It is the most frequently indicated 
remedy for chronic ciliary blepharitis, and a more rapid cure 
can usually be effected by its local application at the same time 
of its internal administration. I use it locally in some unguent, 
as cosmoline, about eight grains to the ounce." (G. S. Norton.) 

Hepar, upper lid-margins unevenly rounded, swollen and red : 
tough mucus in lashes and canthi ; scleral conjunctiva injected 
with red vessels running towards the cornea, where they form 
little vesicles with turbid secretion, lachrymation ; pain in the 
evening, agglutination in the morning ; right eye worse ; small 
pimples or little furuncles on the face, or elsewhere, in complica- 
tion with tinea. 

Kali carb., swelling of lids ; edges, canthi and caruncula red 
and swollen; lachrymation and pain from bright light; pressing 
pain in front of head and temples into the eyes, with heat in face 
and head; after eating, pressure in stomach, belching: nausea 
and emptiness in stomach ; gagging and vomiting of slime : 
pressure and anxious feeling in chest ; face pale, dirty gray. 

Magn. mur., when accompanied with pimply eruption on the 
face, which comes and goes, but is worse alter supper, in a warm 
room, and before the menses. 

Merc, sol., lids smart, are sore and red, especially upper lids ; 
worse at night in bed, from warmth and cold, and from the glart 
of a fire. 

Merc, cor., indurated lids; secretion thin and excoriating; noc- 
turnal aggravation. 



INFLAMMATION OF THE EYELIDS. 135 

Mezer., accompanied by tinea capitis of thick, hard crusts, from 
which pus exudes upon pressure. 

Natr. mur., after the application of nitrate of silver ; after mea- 
sles; acrid lachrymation, excoriating the lids and cheeks and 
making the skin glossy and shining ; eczema. 

Nux vom., after previous drugging and when worse in the 
morning. 

Petrol., pain in the back of the head, rough skin; diarrhoea 
only during the day. 

Phosph. ac, lid-margins swollen, red and rounded ; lashes par- 
tially falling out ; pus particles on lashes and in canthi ; itching 
and burning ; sensitiveness to candle-light ; difficult opening of 
the eyes in the morning. 

Psorin., from right to left ; worse mornings and during the day ; 
old chronic cases ; offensive discharges from the eyes ; photopho- 
bia ; strumous diathesis. 

Pulsat, worse in the evening and in a warm room, better in 
the open air; lachrymal apparatus affected; styes, and acne in 
the face. 

Rhus tox., lids oedematously swollen; copious, acrid and serous 
discharge, corroding the adjacent parts of the cheeks. 

Sepia, " small pustules, like acne, on the edge of the lids ; tight 
feeling in lids ; aggravation morn and eve." (G. S. Norton). 

Silic., objects appear as if seen through a fog, ameliorated by 
wiping the eyes ; fluent coryza, corners of mouth cracked ; offen- 
sive sweat of feet. 

Staphis., lid-margins dry, with hard lumps and destruction of 
the ciliary roots; small tarsal tumors. 

Sulphur, lid-margins thick, granulated and rounded ; dry 
crusts in lashes ; sharp, sticking pains, as if pins or a splinter of 
glass was sticking in the eye ; morning agglutination ; glandular 
swellings on the head and neck; eruption on the face; pale and 
puffed face ; abdomen hard ; disturbed digestion ; worse in the 
evening and gas-light ; cannot bear to have the eyes washed. 

Tellur., eczema impetiginoides on the lids, with pustular con- 
junctivitis ; much purulent discharge from eyes ; offensive otor- 
rhoea. 

Thuja, dry, branny eruption upon the lids, chiefly about the 
ciliae ; lashes irregular and imperfectly grown ; eyes weak and 
watery. 

Anchylops will best be met in the beginning by Apis, Bellad., 
Hcpar, Pulsat, or Rhus tox. 



136 LIDS AND LACHRYMAL APPARATUS. 

Trichiasis may require operative measures; but cases have been 
cured without them. 

Aeon., has been successfully applied in a case of trichiasis and 
entropium. 

Borax, has the symptom, but no verification to my knowledge. 

Graphii, may soften the scars. 

Natr. mur., after abuse of nitrate of silver. 

Sepia, eyelashes gone; edges raw and sore; eversion of puncta; 
eyes full of matter. 

Thuja, dry, branny eruption upon the lids, chiefly about the 
ciliae; lashes irregular and imperfectly grown; eyes weak and 
watery. . 

Entropium is surely amenable to internal treatment, if recent. 

Aeon., acute inflammation with dryness and burning. 

Calc. carb., has cured cases of senile entropium. 

Merc, cor., Rhus tox. and Sulphur, are oftener indicated than 
Lycop. 

Natr. mur., after abuse of nitrate of silver. 

Sepia, acute blepharitis. 

Edropium has been cured by: 

Apis, stinging pains and great cedematous swelling of lids and 
conjunctiva. 

Arg. nitr., tear-points greatly inflamed and prominent. 

Hamam., during the course of a severe conjunctivitis — by exter- 
nal application of "Pond's Extract." 

Merc, cor., Nitr. ac. and Sulphur, have been successfully employed. 

Rhus tox., sac-like swelling of the conjunctiva; cedematous 
swelling of the lids; cilise fall out; acrid lachrymation in the 
morning and in the open air. Lids are spasmodically closed ; on 
opening them, protrusion of a thick red swelling, and yellow 
purulent discharge. 

Hordeolum, Stye. 

It is in its nature a small furuncle, forming in the connective 
tissue near the edge of the lid, and has its name from its fancied 
resemblance to a grain of barley. It appears as a red, hard 
swelling, which rapidly increases until it suppurates and breaks, 
either outside or inside of the lid margin. In some cases it is 
attended with considerable pain, and swelling of the whole lid. 
Some persons are subject to repeated outbreaks of this furuncular 



TUMORS OF THE LID. 137 

inflammation. We find it most frequently in youthful individ- 
uals of rather delicate health with a tendency to acne, or in 
persons addicted to free living or dissipation. If by frequent re- 
lapses it induces inflammatory changes in the Meibomian glands, 
and is followed by fatty or chalky degeneration of their contents, 
it is called Chalazion. 

THERAPEUTIC HINTS.— Pulsat, most frequently used and indi- 
cated ; it often arrests its growth. 

Hepar, if Pulsat. has not been sufficient to prevent suppuration. 

Staphis., often found useful and especially when the stye does 
not suppurate and break, but remains a hard nodule. 

Upper lid: Alum., Caustic, Ferrum, Mercur., Phosph. ac, 
Sulphur. 

Lower lid: Phosphor., Rhus tox., Senega, Staphis. 

Right side: Calc. carb., Canthar., Natr. mur. 

Left side: Colchic, Lycop., Pulsat., Staphis. 

For removing the disposition: Amm. carb., Calc. carb., Ferrum, 
Graphit., Sulphur, Thuja. 

Chalazion: Calc. carb., Conium, Graphit., Pulsat., Sepia, Silic, 
Staphis., Thuja. 

Tumors of the Lid. 

Chalazion has been mentioned under styes. " It is mostly situ- 
ated at some distance from the free margin of the lid and gener- 
ally most manifest on its inner surface, lying close beneath the 
conjunctiva. In rarer cases the tumor points outwards and lies 
close beneath the skin, which is frequently somewhat reddened 
and thinned over and around it. It occurs far more frequently 
in the upper than in the lower lid. (Walton). 

Sebaceous tumors occur most frequently at the outer and upper 
margin of the orbit, close to the eyebrow. Their contents are 
suet-like and sebaceous, consisting of broken-down . epithelial 
cells, fat molecules and hairs; sometimes they are softer and more 
oily. The whole is encased in a cyst wall, the posterior portion 
of which is somewhat thickened and hypertrophied. 

Warts occur occasionally on the edges of eyelids. 

Fatty tumors (wens) are of rare occurrence. "They may be 
recognized by their smooth, circumscribed, somewhat lobulated 
form, and are firm and elastic to the touch." 



138 LIDS AND LACHRYMAL APPARATUS. 

Epithelioma "is the most frequent in occurrence of all malig- 
nant tumors of the lids; arises as a small nodule near the edge 
of lid, and is painless, slow in its progress and at last ulcerates. 
The skin around the ulcer is not swollen and discolored as in 
lupus. The slowness of its growth and the history of the case 
distinguish from syphilitic ulcer." (G. S. Norton). 

THERAPEUTIC HINTS.— Encysted tumors have been cured by: 
Calc. carb., Grapit., Silic, Staphis., Thuja; warts by: Caustic, 
Thuja; wens by. Baryt. carb., Graphit ;. epithelioma by: Apis, 
Hydr. ac, Laches. (G. S. Norton). 

Dacryocystitis 

Is an acute inflammation of the lachrymal sac, which frequently 
reaches its acme in a few days and is very painful. Its swelling 
may extend to the cheek, eyelids and even conjunctiva. In less 
severe cases, or after the acute inflammatory symptoms have 
passed away, pus may be squeezed out of the puncta; but when 
the swelling and thickening of the lining membrane closes the 
passage, or the opening into the sac becomes somewhat displaced 
by it, the pus can not escape, and if left alone, will finally force 
its way thiough the skin. After the discharge of pus, the inflam- 
mation subsides either entirely, and the opening heals, or there 
remains a chronic inflammation of the sac, with subsequent re- 
newals of acute attacks, or the aperture in the skin does not 
firmly cicatrize, but merely scabs over, while fresh pus is col- 
lecting, which again forces its way out at the same place, thus 
finally leaving a fistulous opening, through which a thin, muco- 
purulent discharge and the tears constantly ooze — Fistula lachry- 
malis. Or again the sac may undergo ulceration at one point 
and the matter escape into the neighboring cellular tissue, thus 
giving rise to a secondary sac or pouch, which may break, where- 
by another more or less extensive fistulous opening is established, 
often very obstinate and intractible, especially if the bony struc- 
ture is likewise diseased. Of chronic cases there are instances 
where several such pouches burrow beneath the skin in different 
directions. 

The Causes. — This inflammation is often merely an extension 
of conjunctivitis, especially the granular form, or of nasal catarrh : 
it may be produced by periostitis and caries of the nasal bones 



BLENNORRHEA OF THE LACHRYMAL SAC. 139 

in scrofulous or syphilitic persons, or may occur as a primary 
affection, being then generally due to exposure to cold and wet. 
"Its most frequent cause is a previous stricture of the nasal duct 
or blennorrhea of the lachrymal sac." (G. S. JSforton.) 

THERAPEUTIC HINTS.— Instrumental aid may be required, but 
often bad cases have been cured by internal treatment alone. 
For dacryocystitis, at the beginning, Pulsat., or Apis, when there is 
cedematous swelling and stinging pains, but Bellad., Hepar, and 
Silic. may also be indicated. We will, no doubt, have to consider 
its causes (conjunctivitis, nasal catarrh, etc.), and then compare 
the corresponding remedies. 

Fistula lachrymalis : Bellad., inflammation of the lachrymal 
duct; intolerance of light ; profuse lachrymation ; lid edges in- 
flamed and agglutinated; morning and evening a gritting sensa- 
tion in the lids ; aggravation in the evening. 

Bromine, Cole, carb., Caustic, Fluor, ac, Hepar, Laches., Natr. 
mur., Petrol., Pulsat., Sulphur, Silic, disorganization of the walls 
of the sac; denudation of the internal horny wall and closure of 
the nasal canal. 

Blennorrhcea of the Lachrymal Sac 

Is another consequence which may follow acute inflammation of 
the lachrymal sac, in fact it is a chronic inflammation of that 
organ by which its walls become either thickened and hypertro- 
phied, or thinned and greatly distended, secreting constantly a 
thin, glairy, viscid fluid, which flows down the nasal duct, or 
oozes up through the puncta. When the sac gets filled with this 
secretion, we observe it as a swelling of varying size and hard- 
ness. On pressure its contents discharge through the puncta, 
and the finger sinks in as the sac is being emptied. During 
warm and dry weather the patient usually experiences very little 
inconvenience, while on exposure to cold and damp winds the 
trouble increases, inducing fresh inflammatory action. In this 
way it comes to pass that strictures are formed either in some 
part of the nasal duct, or of the canaliculus near its opening into 
the sac. 

Its Causes are like those of dacryocystitis — conjunctivitis, nasal 
catarrh, periostitis or caries of the nasal bones ; also obstructions 
in the lachrymal passages either above or below the sac by a 



140 CONJUNCTIVA. 

narrowing, obliteration, or eversion of the puncta ; or by contrac- 
tion or stricture of the canaliculus or of the nasal duct ; or by 
polypi or other growths which compress and obstruct the duct. 

THERAPEUTIC HINTS.— Compare the previous article and also 
those which treat of its causes. 

Stammm, " is one of the most important remedies, especially if 
the discharge is profuse, thick and of a yellow white color." 
(Geo. S. Norton.) 

Firm strictures require instrumental aid. 

CONJUNCTIVA. 
Catarrhal Ophthalmia 

Is an inflammation of the conjunctiva which may extend into 
the Meibomian ducts, the canaliculi, and the ducts of the lachry- 
mal gland. In its mild form it shows merely a slight hyperemia 
with a sensation of grit in the eye, itching, stiffness and heaviness 
of the eyelids with or without sticking together in the morning ; 
there is only exceptionally some mucus excreted and found col- 
lected at the inner canthus either fresh or dried into little yellow- 
ish or brownish crusts. It is aggravated by exposure to cold 
winds, when lachrymation is produced. Usually of a chronic 
nature, it is found especially in persons of ill health, and is often 
difficult to cure. 

In its acute form the blood-vessels are much enlarged and ap- 
pear as a vascular net- work of brick-dust, or of bluish or lilac hue, 
especially on the ocular portion of the conjunctiva, while on the 
palpebral portion it is less marked. Often it is accompanied by 
spots of extravasated blood within the meshes of the membrane, 
which swells, and has, especially on its palpebral portion, a villous 
appearance, being due to the engorged state of the villi, an ap- 
pearance which must not be confounded with granular conjunc- 
tivitis. At first there is an increased flow of tears which after a 
while is replaced by a secretion of mucus, which by degrees gets 
thicker and is either whitish or yellowish. If it assume a puru- 
lent character, the mere catarrhal ophthalmia passes into the 
purulent form. Chemosis is very rare; photophobia, pain and 
impairment of vision do not occur in the catarrhal form. In 
severe cases the eyelids participate in the inflammation : usually 






CATARRHAL OPHTHALMIA. 141 

both eyes are effected, not, however, always simultaneously ; the 
second often becomes involved when the first is getting well ; it 
always shows an evening aggravation; and is apt to recur. Its 
Causes are: mechanical and chemical irritation; getting cold and 
wet ; excessive strain of the eyes by artificial light ; extension 
from inflammatory processes of neighboring parts; measles, scar- 
let fever, small-pox; sometimes it appears epidemic. It is infectious. 

THERAPEUTIC HINTS.— If caused by some foreign body, this 
ought to be removed. 

Aeon., reduces the inflammation caused by a piece of steel or 
cinder and facilitates its removal, if that could not be effected 
before the inflammation had fully developed. If there remains 
still some inflammation after Aeon., Sulphur will cure it. 
Aeon, is also indicated at the beginning of any ordinary ca- 
tarrhal conjunctivitis, where there is great dryness, burning and 
heat in the eye and where it has been brought on by exposure to 
sharp, cold winds. 

Apis, cedematous swelling of lids and skin over orbits with red- 
ness, heat and sensitiveness to external covering; stinging pains. 

Arg. uitr., profuse discharge approaching a purulent character; 
feels better in the open air, worse in a warm room. 

Arsen., lids spasmodically closed ; conjunctiva of a dark, violet 
color; secretion thin and acrid with burning pain, worse at night. 

Bellad., right eye; throbbing pain; hot tears or dryness of the 
eyes; light is painful; nose sore from coryza; headache and simi- 
lar Belladonna symptoms. 

Chamom., often for infants after exposure to cold while bathing 
and washing. The children cry much ; have colic and green 
stools; also during dentition. Extravasation of blood sometimes. 

Couium, right eye bloodshot; aches on lying down to sleep; 
thirsty; sweat on head, face and neck. 

Crocus, feeling in the eyes as after weeping with a correspond- 
ing appearance, extending from left to right eye ; feeling of some- 
thing alive and moving in the abdomen. 

Digit, chronic; a yellowish redness of the palpebral conjunctiva. 

Euphras., acrid tears and profuse, acrid, thick and yellow dis- 
charge ; blurring of vision relieved by winking ; coryza with 
burning and pain in the frontal sinuses ; after exposure to cold 
and during the first stage of measles. 

Grraphit, chronic; thin, acrid discharge; external canthi crack 



142 CONJUNCTIVA. 

and bleed easily; nose sore and excoriated, with crust on the 
nostrils. 

Merc, sol., blenorrhoea, thin and acrid ; great swelling of lids ; 
sensitive to touch ; worse in a warm room or in the cold air, and 
in damp weather; also from evening till midnight; no relief 
from sweat ; frequent relapses. 

Nux vom., the inner canthi are more inflamed than other parts; 
bloody exudation; smarting like salt; all worse in the morning. 

Pulsai, bland, moderately profuse, white discharge; worse in 
the warm room; in the evening; from reading; better in the 
open air. 

Rhus tox., cedematous swelling of the lids; chemosis of con- 
junctiva ; great restlessness ; after getting wet. 

Sepia, muco-purulent discharge in the morning and dryness in 
the evening; the conjunctiva is of a dull, red color with some 
photophobia and swelling of the lids, especially in the morning. 

Sulphur, acute and chronic ; sharp, darting pains, like pins 
piercing the eye ; severe pain darting through the eye back into 
the head, from 1 to 3 a.m., waking the patient from sleep ; fever- 
ish and restless at night. 

Zincum, the inner half of the eye is the most affected part, with 
much discharge ; worse in the evening and in the cool air. 

Purulent Ophthalmia. 

Commencing with mere congestion, itching and dryness, par- 
ticularly at the inner corner, it gradually augments to intense in- 
flammation of the whole conjunctiva with considerable mucous 
secretion, which soon is changed into a purulent discharge, dis- 
solved in the tears. The lids swell and become slightly everted, 
the conjunctiva is dark red and the single blood-vessels are no 
longer to be seen. The parts affected feel hot and scalding with 
neuralgic pains which may extend to the temple and forehead. 
As the disease progresses, Chemosis sets in, that is an infiltration 
of the conjunctival and subconjunctival tissue, and in addition 
we observe spots of extravasated blood. In this way the con- 
junctiva swells often to a degree that it overlaps the cornea, but 
shows itself most prominently at the lateral sides of the eyeball, 
where it receives the least pressure from the eyelids. The in- 
flammation generally spreads to the areolar tissue of the orbits 
together with the tunica vaginalis oculi, causing a slight protru- 



PURULENT OPHTHALMIA. 143 

sion of the eyeball ; the eyelids swell still more and the upper 
overlaps the lower, while the protruding conjunctiva always 
everts the lower and sometimes both. The protruding part of 
the conjunctiva is very marked in its villous appearance. If 
cured in this stage, the eye may escape serious injury. But if it 
goes on the palpebral papillse may undergo a change which is 
called granulation, of which later ; the cornea may be rendered 
opaque by interstial changes, or it may be destroyed by soften- 
ing and ulceration ; the iris may inflame and adhere to the 
cornea ; the vibrous body, the retina, and the choroid may be 
partially or quite spoiled ; the sclerotica may become softened ; 
the crystalline lens, when not discharged through the perforated 
cornea, becomes quite yellow ; and all this destructive process 
may run its course in a space of time from a few days to three 
weeks. 

This dreadful disease is most common and severe in hot cli- 
mates; in temperate latitudes it is found more especially in the 
army, navy, in workhouses, prisons and among the poor ; it is 
chiefly endemic and spreads by infection. 

Gonorrhoeal ophthalmia, which has been developed by infection 
from urethral pus, cannot be distinguished from the purulent 
form, except by the history. It is one and the same kind of 
inflammation, only intensified, destroying the eye with great 
rapidity. 

Ophthalmia neonatorum "is essentially the same disease as pu- 
rulent ophthalmia in the adult, merely modified by the undevel- 
oped tissues of the babe, and the activity of the growing processes, 
the infant organism, but it is generally more severe." (Walton.) 
Usually about three or four days after birth it commences with 
some slight redness of the lids and slight discharge; the eyes are 
kept closed; light is distressing; then gradually the lids swell, 
and the purulent discharge becomes profuse, when the whole 
train of symptoms, above described, may be considered as fairly 
set in motion. But fortunately not all cases are of this virulent 
nature; simple catarrhal inflammation, caused by chilling the 
child when bathing or washing it, or using strong soap, which 
irritates the eyes — may as well commence at that time; the pu- 
rulent form originates from leucorrhceal or gonorrhoeal dis- 
charges of the mother transmitted to the eyes of the child during 
parturition. 



144 CONJUNCTIVA. 

THERAPEUTIC HINTS.— As in all three forms of purulent oph- 
thalmia the discharge is poisonous; great care should be taken 
as to cleanliness in nursing such cases. 

Apis, cedematous swelling of the lids and adjacent cellular tis- 
sue; conjunctiva congested, puffy, chemosed; lids everted, vil- 
lous; cornea grayish, smoky, opaque; burning, stinging pain; 
photophobia and hot lachrymation. 

Arg. met, purulent; infant; any effort to separate the lids 
caused a drawing-in of their edges. (After Sulphur and Calc. 
carb. had been without effect.) 

Arg. nitr. Allen and Norton have witnessed the most intense 
chemosis with strangulated vessels, most profuse purulent dis- 
charge and commencing haziness of cornea with a tendency to 
slough, subside rapidly under this remedy in its 30th potency 
internally, and at the same time a solution of five or ten grains 
to two drachms of water of the 1st, 3d or 30th dilution as an ex- 
ternal application. The very absence of subjective symptoms, 
with the profuse purulent discharge and the bulging lids from 
a collection of pus underneath or from swelling of the sub-con- 
junctival tissues, and not from infiltration of the connective tis- 
sue of the lids themselves (as in Rhus or Apis), indicate this drug. 

Arsen., is characterized by a thin and corroding discharge with 
great burning pain and restlessness; after abuse of nitrate of 
silver. 

Calc. carb., profuse, yellowish-white discharge ; ulceration of cor- 
nea ; oedema of lids ; later opacities of cornea ; well-known Cal- 
carea symptoms ; after working in the water. 

Chamom., ophth. neonatorum ; lids much swollen , conjunctiva 
bleeding when separating the lids ; child cries much ; wants to 
be carried about ; has colicky pains and green discharges. 

Euphras., compare catarrhal ophthalmia. 

Hepar, purulent secretion in scrofulous subjects ; lids swollen, 
spasmodically closed, bleeding easily on attempting to open them 
and sensitive to touch; intense photophobia; throbbing pain. 
better from external warmth, worse from any draught of cold 
air. Ulceration of cornea and hypopion ; affection of Meibomian 
glands. 

Lycop., ophth. neonatorum ; copious discharge of pus ; the lids 
are puffed out by pus beneath ; the conjunctiva looks like a piece 
of raw flesh. 

Merc, sol., ophth. neonatorum; thin, excoriating secretion from 






GRANULAR OPHTHALMIA. 145 

the eyes; green, diarrhoeic stools with straining; soreness of 
anus ; jaundice ; syphilitic and gonorrhceal infection. The other 
mercurial preparations have also been successfully used. 

Natr. mur., especially as an antidote to nitrate of silver, so 
frequently abused. 

Nitr. ac, especially as an antidote to mercurial and syphilitic 
poison. 

Pulsat, ophth. neonatorum ; profuse and bland discharge; from 
gonorrhceal poison ; all worse in. the evening and better in the 
open air. Allen and Norton found it of great benefit as an in- 
tercurrent remedy when Arg. nitr. seemed to give out. 

.Rhus tox., cedematous swelling of lids, and of conjunctiva; 
great restlessness ; after getting wet; commences on the left eye. 
The discharge is profuse, or tears are gushing out of the eye. 

Sulphur, often in chronic cases with an outspoken psoric 
cachexia. 

The gouorrhoeal and syphilitic form may require besides the 
remedies mentioned: Caimab., Cinnab., Carb. veg., Kali bich., 
Phytol., Tart, emet., Thuja. 

Granular Ophthalmia. 

" Under granular ophthalmia are classed two different forms 
of conjunctivitis, follicular and granular. The former is an accu- 
mulation of lymphoid elements. It never involves the deep 
structures of the lids or surrounding conjunctiva, and, therefore, 
disappears without leaving cicatricial changes. It is character- 
ized by round or oval, pale red prominences, often arranged in 
rows in oculo-palpebral folds, especially lower and accompanied 
with some catarrhal symptoms of conjunctiva. 

True granular conjunctivitis is a much deeper and more 
serious form of inflammation. It involves deeply the stroma of 
conjunctiva (palpebral), as is shown by the proliferation of 
papillae and development of so-called granulations. It always 
leaves scars behind, causes pannus, serious results to vision, 
entropion, trichiasis and other disorders, which is not the case 
in follicular conjunctivitis. It also especially involves the upper 
lid. It may be acute or chronic. The two diseases may be 
found together." (G. S. Norton). 

By the continual friction of the granules upon the cornea the 
latter may become hazy, rough or semi-opaque and vascular, a 

10 



146 CONJUNCTIVA. 

state which is known under the name of Pannus, though this 
opacity and vascularity of the cornea may also be produced by 
trichiasis, or any friction of the lid-edges. The granular eyelid 
is usually attended with great sensitiveness to light, cold air, 
wind, dust and smoke; reading, writing and sewing causes pain 
in the eyes and an increase of redness; there is mistiness of 
sight; rainbow colors around luminous bodies and finally, when 
the cornea more and more degenerates and even deeper portions 
of eyeball become involved in the inflammatory process, sight 
may be considerably damaged. 

Causes. — Being not a specific disease, it usually is the conse- 
quence of neglected conjunctivitis, which has become chronic. 
We find it, therefore, most frequently among the poor, and as in 
all ophthalmias the secretion is infectious, it too is propagated 
by infection, and consequently most prevalent where large masses 
of people are crowded together. " But the commonest of all ex- 
isting causes, is the use of nitrate of silver in substance for the 
primary inflammation, or in lotions or salves, of such strength 
as to be highly irritating." (Walton.) 

THERAPEUTIC HINTS.— Aeon., in acute aggravations by over- 
heating or exposure to dry, cold winds. 

Alum., upper lids are weak and hang down loosely. 

Arg. nitr., being so often the cause of granular lids, it surely 
must do good, where it has not been abused: compare the for- 
going chapters. 

Arsen., see purulent ophthalmia; lids spasmodically closed: 
palpebral conjunctiva inflamed, raw and suppurating ; cornea 
degenerated ; on the face a fine eruption : under the eyes excor- 
iated places by the acrid discharge, which are sometimes covered 
with crusts. 

Aurum, with pannus : great photophobia ; hot, burning tears 
when attempting to open the eyes : excoriation on the cheeks 
and swollen glands on the neck : after the abuse of Mercury. 

Bellad., acute aggravations witli great photophobia. 

Calc. carb., with pannus ; caused by working in the water ; 
deafness or ear discharges : sweat on forehead ; thick, red nose 
with acrid discharge, or nose stopped up ; swollen upper lip ; 
swollen glands on neck ; large abdomen : desire for boiled eggs. 

Euphras., with or without pannus ; profuse lachrymation and 
thick discharge, excoriating lids and cheek. 









PHLYCTENULAK OPHTHALMIA. ] 47 

Kali bich., with pannus ; everything appears slightly reel ; eyes 
feel better when lying on the face. 

Merc, prsec. rub., with pannus; old chronic cases. 

Merc, protojod., with pannus, and superficial ulceration upon it. 

Merc, bijod., "of great value in old cases of granular lids and 
pannus." (G. S. Norton.) 

Natr. mur., the most important remedy after cauterization, espe- 
cially with nitrate of silver. 

Nux vom., often gives great relief after many other crude drugs 
have been employed. 

Petrol., with pannus; occipital headache; roughness of skin; 
scrofulous habit. 

Pulsat, papillary trachoma without pannus in tearful females ; 
with evening aggravation and amelioration in the open air. 

Rhus tox., with pannus and profuse lachrymation. 

Sulphur, when other remedies fail to act; often better indicated 
by other than eye-symptoms; the psoric tendency of the patient 
and his dislike to water and the like. 

Thuja, granulations large, wart-like; pain worse at night, after 
midnight. 

The following remedies are mentioned favorably: Alumen 
exsiccatum, Caustic, Chin, mur., Chin, tan., Cinnab., Conium, 
Cupr. al., Cupr. sulph., Hepar, Merc, sol., Natr. phosph., Sepia, 
Tart, em., Zincum. 

Phlyctenular Ophthalmia. 

The phlyctenula commences as a little vascular patch, at the 
summit of which the epithelium is raised by serum into a vesi- 
cle; the conjunctiva swells, the vessels enlarge, profuse lachry- 
mation ensues, and a catarrhal discharge is produced. By this 
time the vesicle bursts and a little ulcer is formed which secretes an 
opaque grayish substance, under which the ulcer may heal, if the 
inflammation does not extend, before the repair is effected. The 
phlyctenular appear most frequently at the corneo-scleral border, 
sometimes also on the cornea, and exceptionally on the oculo- 
palpebral or palpebral conjunctiva. They appear either singly or 
there may be several scattered about or in groups, and sometimes 
disposed in a circular manner, partially surrounding the cornea. 
Ordinarily the redness is only on one side of the eyeball, where 
the eruption is located; sometimes the whole conjunctiva is 



148 CONJUNCTIVA. 

inflamed. At its outbreak it is attended with stinging and itch- 
ing; photophobia is not very great, but increases as the inflam- 
mation is nearer or at the cornea. 

Causes. — 111 health, debility; hereditary weakness, impure air, 
insufficient diet and clothing, want of exercise; exposure to wet 
and cold. 

THERAPEUTIC HINTS include those for pustular keratitis and 
so-called ophthalmia scrofulosa. 

Apis, eyelids puffed; conjunctiva chemosed; cornea grayish, 
smoky, opaque; pain burning-stinging. 

Arsen., lids spasmodically closed; conjunctiva and cornea pus- 
tulous and ulcerated; lachrymation and discharge excoriating 
the surrounding parts; burning pain; nose and upper lip exco- 
riated by acrid discharges; great restlessness and thirst. 

Aurum met, great photophobia; hot, burning tears; cutting 
pain through the eyes, sensitive to touch; swollen glands on 
neck ; after mercurial poisoning. 

Baryt. carb. and jod., enlarged cervical glands. 

Calc. carb. and jod., scrofulous subjects; from exposure to wet, 
and worse during damp weather; complication with deafness; 
swollen glands, etc. See previous chapters. 

Caustic, pain relieved by external pressure; yellow face; warts 
on nose or eyebrows. 

Chamom., compare under purulent ophthalmia. 

Cinnab., pain from inner canthus across the eyebrows or around 
the eye. 

Conium, great photophobia without much imflammation of the 
conjunctiva. 

Crot. tigl., with a corresponding eruption on face and lids. 

Euphras., compare previous chapters. 

Graph.it, often indicated in the chronic and acute form: the 
external canthi are cracked and bleed easily when opening the 
eyes; intense photophobia. 

Hepar, ulcers on cornea; intense photophobia, lachrymation 
and great redness, even to chemosis; pain throbbing, better from 
external warmth; scrofulous, cross children; abuse of mercury. 
Hypopion. 

Kali bichr. and hydr., absence of pain, of photophobia and red- 
ness ; secretion of a stringy character. 

Merc, sol., ulcers, and chalk- white appearance of the cornea : 






PHLYCTENULAR OPHTHALMIA. 149 

lids swollen and spasmodically closed; intense photophobia; ex- 
coriating lachrymation ; pain worse at night; excoriation of 
nose; ulcers on tongue; eruption on face and head; aching in 
the bones; syphilitic subjects. These symptoms fit more or less 
to other mercurial preparations, of which there have been 
used with success — 

Merc, corr., when the acridity seems still more intense. 

Merc, nit, has been used with great success by Dr. Liebold in 
this form of inflammation, whether acute or chronic. 

Merc, prsec. rub., differs little from the others. 

Merc, protojod., when the tongue has a thick, yellow coating at 
the base. 

Natr. mur., lachrymation and discharge acrid and corroding; 
after the abuse of nitrate of silver. 

Nux vom., after much drugging; morning aggravation. 

Psorin., chronic cases with psoric taint. 

Pulsat, phlyctenular confined to the conjunctiva. Compare 
former chapters. 

Rhus tox., pimples and vesicles on the cornea; great photopho- 
bia and intense inflammation; eruptions on head and face; swel- 
ling of glands behind the ears. Compare previous chapters. 

Sepia, complication with uterine affections; aggravation morn- 
ing and evening. 

Silic, suppurating and perforating ulcers on the centre of the 
cornea, without blood-vessels running towards it; neuralgic pain 
in supraorbital nerve; phlyctenules on the boundary of sclera 
and cornea, recurring often. After vaccination. 

Sulphur, very often indicated by the general state of the patient, 
or when other remedies fail to relieve. The pain is sharp and 
piercing through eye into the head; worse at nights; eruptions 
on other parts of the body; swollen glands; diarrhoea early in 
the morning; water and washing aggravate, and there is a general 
dislike to being washed. 

Tart, emet, photophobia and herpetic eruptions. 

Tellur., complicated with offensive otorrhcea. 

Zincum, persistent redness, especially at the inner angle and 
worse in the evening and in the open air, remaining after pustu- 
lar keratitis. 

Still other remedies have been found useful : Arg. nitr., Bapt. 
tinct, China, Chloral, Cuprum al., Ferrum, Ferr. jod., Hyosc, 
Kreos., Laches., Lycop., Magn. carb., Mezer., Nitr. ac, Petrol., 
Phosphor., Podoph., Sulph. jod., Thuja. 



150 CONJUNCTIVITIS. 

Diphtheritic Conjunctivitis. 

Like diphtheritis of the pharynx, it is an inflammation of the 
entire conjunctiva, which becomes tumefied by a corpuscular in- 
filtration of newly-formed cells into the subepithelial connective 
tissue, so abundant as to compress the blood-vessels and arrest 
the circulation and nutrition, in consequence of which the con- 
junctiva degenerates into a necrotic mass, and is thrown off in 
pus-like secretion. On examining the eye, the conjunctiva ap- 
pears as if covered with a felted flocculent membrane of a pale 
yellowish or grayish hue, especially on the palpebral conjunctiva 
and on the oculo-palpebral fold. The eyelids are swollen, hard, 
stiff and hot. Often the internal parts participate in the inflam- 
matory process. After six to eight days the active inflammation 
subsides, the exudation dissolves and is thrown off as a pus-like 
discharge, when finally the injured parts heal and become cica- 
trized, involving sometimes the cartilage and deeper tissues of 
the lids, and causing entropion, symplepharon, secondary corneal 
affections, etc. It ought to be born in mind, that the diphtheritic 
conjunctivitis is the most destructive form of external inflamma- 
tion of the eye and that its discharge is extremely contagious. 

Causes. — In Northern Germany it has appeared as an epidemic ; 
in this country only sporadic cases have been seen. Some say, 
purulent ophthalmia may be converted into this form by the 
improper use of escharotics; it may be inoculated and it may be 
idiopathic, its cause lying in constitutional conditions, and be 
complicated with diphtheria in the throat, with scarlet and puer- 
peral fevers, and even with measles. It in ay attack voung and 
old. 

THERAPEUTIC HINTS must be more or less identical with those 
given under Diphtheria, which compare. 

Croupous Conjunctivitis 

"Is much more common and should be distinguished from diph- 
theritic. The lids are swollen (usually cedematous), but not firm 
and hard, as in diphtheritic, The false membrane is present to 
a greater or lesser extent and more or less adherent, but it is on 
the surface of the conjunctiva (especially palpebral) and does not 
leave cicatrices behind, while in the diphtheritic form the exuda- 



PTERYGIUM. 1")1 

lion is in the stroma of the conjunctiva and cicatrization always 
results. Croupous conjunctivitis is therefore much less serious 
than diphtheritic, though the former may pass over into the latter. 

THERAPEUTIC HINTS.— Acet. ac. is particularly the remedy when 
the membrane is yellow, white and very dense, tough and adherent. 

Arg. nitr., after degeneration of the membrane has set in and 
the discharge is more purulent. 

Kali bichr., if the membrane is loosely attached and comes off in 
strings and threads." (Geo. S. Norton.) 

Pterygium. 

This is a triangular or wing-shaped adventitious growth on 
the ocular conjunctiva. Starting with its broad base at the cor- 
ner of the eye, it reaches with its apex (seldom the middle, and 
still more seldom crossing the middle) of the cornea. It is loosely 
connected with the conjunctiva. It generally makes its appear- 
ance at the inner — rarely at the outer — corner of the eye. Very 
rarely it appears on the upper or lower part of the eyeball. 
These growths are of different consistency and color : some look 
red, inflamed, and are full of blood-vessels; some are quite thin, 
almost transparent ; and still others are thick and of a whitish 
or yellowish hue. 

Their origin is usually due to a chronic inflammation of the 
conjunctiva, and therefore always preceded by increased vascu- 
larity of the spot of the conjunctiva in which it appears. Tropi- 
cal influence is considered as an excitant. It appears after the 
adult period ; but there are also congenital cases. 

THERAPEUTIC HINTS.— Arg. nitr., pink color; discharge from 
the eye ; inflammation better in the open air, unbearable in a 
warm room, with pain at the root of the nose. 

Arsen., dryness and burning in the eye; or acrid lachrymation 
and discharge. 

Calc. carb., from exposure to wet and cold. 

Zincum, thick, and vascular; conjunctiva injected; lashes in- 
clined to turn inward; external canthi sore and cracked; eyes 
feel sore in cold air, better in a warm room ; itching and lachry- 
mation at night ; green halo around candle-light ; rush of blood 
to the head over face, followed by perspiration over body ; press- 
ure across the root of the nose and supra-orbital region. (Dunham.) 



152 COKNEA. 

Still other remedies have proved useful : Chimaphila, Laches. 
Nux mosch., Psorin, Ratan., Spigel., Sulphur. 



CORNEA. 
Corneitis, Keratitis. 

Inflammation of the cornea is always attended by some degree 
of inflammation of the surrounding conjunctiva and sclerotica. 
Ordinarily its epithelial layer is first affected ; it becomes visible 
by the molecular cloudiness of its cell contents and the prolifera- 
tion of the cells themselves; this is followed by a subepithelial 
infiltration which may involve the true corneal elements. In 
this way the cornea swells; the epithelial layer becomes rough 
and loses its polish, and the anterior portion of the true cornea 
assumes a general dulness or grayish opacity of different degrees. 
The blood-vessels, in fine net-work superficially arranged, follow 
the opacity from the circumference, being formed in the exuded 
material, whereby the cornea is reddened; they communicate 
with the blood-vessels of the conjunctiva. This affection is al- 
ways accompanied with photophobia, lachrymation, blepharo- 
spasm and pain ; the amount of interference with vision depends 
on the amount of the opacity over the pupil. Its causes are 
either mechanical or chemical irritations. 

When phlyrtcnulee form on the cornea, the affection is usually 
called Strumous or Scrofulous ophthalmia: it is frequently associ- 
ated with phlyctenules or pustules on the conjunctiva, as de- 
scribed under "phlyctenular ophthalmia," which compare. 

When the inflammatory symptoms are more chronic in char- 
acter and the destructive effects are deeper and greater, it is 
termed Diffuse or Parenchymatous corneitis. 

"The cornea has then lost its natural polish and resembles a 
piece of glass that has been breathed on. Or it may have a more 
stippled aspect, with greater roughness, whereby there is more 
haziness. With this there is a deep-seated, streaked or speckled 
whiteness or yellowishness, arising from interstitial deposits of 
materials in the true cornea. The true corneal tissue is not long 
pervaded by opacity in any form, before such opacity commences 
to be injected with blood-vessels, which may be few and isolated, 
or numerous and close, looking like a red patch." (Walton.) 
Pain, photophobia, and plepharospasm seldom exist, except in 



CORNEITIS, KERATITIS. 153 

the beginning of the disease. Its spoiling effects may be changes 
in the curves of the cornea causing myopia or astigmatism; or 
limitation of vision; adhesion of the iris to the cornea; changes 
in the deeper parts of the eye; even atrophy of the eyeball from 
ophthalmia. 

Causes. — External injuries to the cornea and constitutional 
derangements, especially hereditary syphilis. 

When by long-continued mechanical irritation from cicatrizes 
of the eyelids, from the contact of the cilia in trichiasis and 
entropium, from granular conjunctivitis the cornea becomes in- 
flamed, cloudy and vascular, or even vascular granulations ap- 
pear, especially on the upper half of the cornea in consequence of 
the greater irritation of the upper lid— we have Panims. As the 
vascularity increases, the cornea is ultimately surrounded by a 
thick tumefied network of varicose vessels, interspersed with 
numerous reddish-brown granulations. 

When in consequence of inflammation suppuration takes place 
between the layers of the corneal lamina?, we have an Interstitial 
abscess of the cornea, which appears either as a yellowish spot with 
whitish circumference in any part of the cornea, or as a deposit 
of pus diffused throughout the cornea, so that the whole looks 
yellow. The pus may gravitate to the lower margin of the 
cornea, forming there a curved line which resembles the white 
mark at the root of the nail, hence it is called Onyx. 

When in consequence of inflammatory proliferation of the epi- 
thelium of the posterior elastic membrane of the cornea an exu- 
dation of mucus and pus corpuscles takes place into the anterior 
chamber, we have Hypopion. The quantity of this exudation 
may be merely recognizable or may fill both chambers of the 
eye. Its color is usually creamy, but it may be streaked red 
with blood, or altogether red from the same. In changing the 
direction of the head from the perpendicular, the loosely lying 
mass shifts its position in the chamber and is therefore readily 
distinguished from onyx. 

When, however, in consequence of inflammation of the con- 
junctival layer of the cornea, its substance becomes rough and is 
cast off or exfoliated, and the breach constitutes an ulcer, we then 
have a surface abscess, or as it is termed Ulceration of the cornea 
The ulcer may appear at any part of the cornea; it may be 
superficial or deep, even penetrating the cornea. The surround- 
ing conjunctiva and sclerotica become vascular, and the more 



154 CORNEA. 

so as the ulcer is nearer the margin of the cornea. Deep ulcera- 
tion excavates the cornea and the spot becomes covered with a 
pus-like material ; it may perforate the cornea, when the aqueous 
humor flows off; it may be associated with onyx or hypopion. 
The subjective symptoms are those of interstitial conjunctivitis, 
and its causes the same. Iritis is no uncommon complication. 
It may result in opacity of the cornea (Leucoma, Macula cornese), or 
in spherical or conical protrusion of the remaining posterior por- 
tion of the corneal tissue, and of the posterior elastic lamina, 
when it is called Ulcerative corneal staphyloma; or the ulcerated 
surface may heal over and cicatrize, leaving, however, the cornea 
still protruding. This is called Cicatricial corneal staphyloma: its 
most prominent part is the thinnest and the surrounding cornea 
is often curved in several directions and affected with superficial 
and interstitial opacity. The staphyloma may burst. When in 
case of perforation of the cornea the iris falls against or into the 
gap, it either protrudes through the opening, or in case of cicatri- 
zation of the opening, the cornea yields in consequence of the 
intra-ocular pressure and gradually bulges forward, giving rise 
to a Partial staphyloma of the cornea and iris; a total destruction 
of the cornea by sloughing or ulceration causes Total staphyloma 
of the cornea and iris, in which process mostly the neighboring 
portion of the sclerotica, and in time, the whole anterior half of 
the globe becomes involved. 

THERAPEUTIC HINTS.— Keratitis, when caused by mechanical 
irritation requires: Aeon., and later Sulphur; Euphras. with a 
feeling as if a hair were hanging over the eye ; Symphitum, with 
a feeling as if the lid were moving over a ball. Besides may be 
indicated: Arnica, Calend., or Hamam. When caused by chemical 
irritation we will have to look for the corresponding antidotes 
of the different chemicals. Arnica is most important in prevent- 
ing suppuration. 

Phlyctenular corneitis requires the same treatment as detailed 
under phlyctenular conjunctivitis. 

Diffuse or Parenchymatous corneitis. Merc. sol. and other mer- 
curial preparations are the most important. Besides compare : 
Apis, stinging burning pain and edematous swelling ; Arsen., 
burning pain and restlessness; Aur. mur., hereditary syphilis: 
"I have found it more commonly indicated than any other 
remedy." (Geo. S. Norton.) Baryt. jod., greatly enlarged cervi- 



CORNEITIS, KERATITIS. 155 

val glands and bone-pains at night; Calc. carb. and jod., stru- 
mous habit ; Cann. sat, Hepar, promotes absorption ; Sepia, uter- 
ine disturbances; Sulphur, promotes absorption. 

Pannus. Apis, Arg. nitr., Arsen., Aurum, Bellad., Cannab., Chin, 
mur., Euphras., Graphit, Hepar, Kali carb., Merc, sol., protoj. and prsec. 
rub., Natr. mur., Petrol., Pulsat, Rhus tox., Sulphur. For particular 
indications compare granular ophthalmia and the following. 

I Ulceration of the cornea. " Bandaging is of the very greatest im- 
portance in the treatment of ulcers of the cornea. See page 205 
Allen and Norton's Ophthalmic Therapeutics." (Geo. S. Norton.) 

Act. rac, sharp, neuralgic pains through the eye into the head. 

Apis, stinging-burning pain and cedematous swelling. 

Arg. nitr., profuse discharge; halo around the light; darting 
pain through eye, morning and evening; better in open air; 
worse in warm room. 

Arsen., burning, acrid, profuse lachrymation ; photophobia ; 
pain worse after midnight; with restlessness; better from warm 
applications. 

Asaf., iris affected with pain in the direction from within out- 
wards ; better from rest and pressure. 

Aurum, with pannus ; great photophobia and profuse, scalding 
lachrymation ; pains go from without inwards ; cervical glands 
enlarged and inflamed. 

Calc. carb. and jod., for scrofulous children with large heads, 
open fontanels, slow dentition; pot-belliedness ; frequent ca- 
tarrh of nose and bowels ; pale face ; enlarged tonsils and cervi- 
cal glands. 

Chamom., cross, peevish children who want to be carried about 
all the time, etc. 

Chin, mur., with pannus ; severe intermitting pains ; anaemic 
conditions of malarial origin. 

Cimic. See Act. rac 

Cinnab., pain above the eye, extending from the internal to the 
external canthus, or running around the eye. 

Conium, superficial ulceration with intense photophobia and a 
gush of tears whenever the spasmodically closed lids were forced 
open ; with all this but little redness of the conjunctiva. 

Crot. tigl., pain in the supra-ciliary region at night and vesi- 
cular eruption on the face and lids. 

Euphras., burning flow of corrosive tears and a feeling of a 
foreign substance in the eye, as of a hair ; blurring of the eyes 



i 



156 CORNEA. 

relieved by frequent winking ; is followed well by Calc. carb. and 
later by Silic. 

Graphit., great photophobia ; profuse lachrymation ; superficial 
or deep ulcers ; hypopion ; lids red and sore, covered with scales ; 
chronic eczema on head, behind ears, on face. The external 
canthi are prone to crack and bleed. 

Hepar, torpid ulceration ; hypopion ; also profuse lachrymation 
or want of lachrymation ; great redness of cornea and conjunc- 
tiva ; throbbing pain, better by warmth, worse by cold, or un- 
covering the eye in the evening. Strumous, outrageously cross 
children; chilliness, desire to be covered; mercurial poisoning. 

Kali bichr., indolent ulceration without photophobia or red- 
ness ; little pain ; slight (if any) discharge of a stringy character. 

Kali carb., ulcer in centre; no photophobia; pale, fat and flabby 
children. 

Merc, cyan., trachoma with pannus ; intense pain in eyeball, 
orbit and supraciliary region and head ; worse on lying down ; 
nocturnal pains in the joints ; syphilitic origin. 

Merc, proi, serpiginous superficial ulceration of the cornea; 
much vascularity and photophobia ; tongue yellow at base. (Geo. 
S. Norton.) 

Merc, sol., and other mercurial preparations compare under 
phlyctenular conjunctivitis. 

Natr. mur., acrid tears and discharge ; sharp piercing above eye 
on looking down ; after cauterization. 

Nitr. ac, is often indicated after Calc. carb., or Pulsat. 

Nux vom., Pulsat, compare previous chapters. 

Rhus tox., after getting drenched ; compare former chapters. 

Secale, worse from warm applications. 

Silic, deep ulcers ; sloughing ulcers ; hypopion ; the patient 
wants to have his head wrapped up : after vaccination. 

Sulphur, acute and chronic form; hypopion; otorrhcea; eczema; 
affection of the bones. Cannot bear being washed. " The pains 
of Sulphur are usually sharp and stitching, as if a needle or 
splinter were sticking in the eye. They do not extend into the 
head, with the exception of the shooting pain through the eye 
into the head from 1 to 3 a.m." (Geo. S. Norton.) 

Thuja, syphilitic origin ; hypopion ; pain over the eyes, as if a 
nail were being driven in. 

Vaccin., with small-pox and after vaccination ; also Variol. 

Opacities have been cured especially by Calc. carb.; but the 



SCLERITIS, SCLEROTITIS. 157 

following have also been successfully employed : Apis, Aurum, 
Cannab., Chelid., Crotal., Cupr. al., Euphras., Hepar, Kali bichr., 
Natr. sulph., Nitr. ac , Phosphor., Pulsat., Rhus tox., Silic, Spongia 
and Sulphur. 

Staphyloma. — Notwithstanding several denials from persons 
■who did not know anything about it, 

Apis did cure, or to say the least, did reduce under my own 
observation a staphyloma to a degree, that the eye regained its 
former usefulness. Years after the same doubts were thrown 
upon Dunham's cure of a pterygium. Although such doubts do 
not alter the facts, yet they do injury by disheartening the young 
physician from even trying to do his best. It seems scarcely 
necessary to mention, that Apis, in order to be successful, must 
correspond with the symptoms of the case. 

Schelling cured a staphylomatous protrusion by Euphras. and 
Lycop. (Allg. H. Zig., 36, 148), and so did Stapf by the gradual 
administration, according to the symptoms, of Sulphur, Calc. carb., 
Nitr. ac, Pulsat, Euphras., and Senega; there remained at last a 
mere slight opacity of the cornea and some distortion of the iris ; 
the protrusion of the cornea had been entirely removed (Arch. 
18, 2, 45). 

Bellad., Hepar, Mercur. and other remedies may also be indi- 
cated, but if we give up before trying, how shall we find out? 

Hypopion has been cured by : Hepar, Silic, Sulphur, Thuja. 

SCLEROTICA. 
Scleritis, Sclerotitis. 

Inflammation of the sclera takes place around the cornea and 
is usually circumscribed, especially between the insertion of the 
recti muscles; it is characterized by a bluish-red elevation, due 
to increased vascularity and lymphoid infiltration in the episcle- 
ral tissue, and by bright red vessels on the surface; it is usually 
painful to touch. Although at times complicated with choroiditis, 
it is not always a sign of hyperemia of the choroid, because there 
are severe cases of choroiditis without any scleral complication, 
and vice versa severe cases of scleritis without choroidal affection. 
When the uveal tract is involved it is usually the iris or ciliary 
body and not the choroid, as both (iris and ciliary body) are 
supplied by the anterior ciliary vessels in common with the 
sclera. (Norton.) 



158 iris. 

Repeated attacks of scleritis tend in time to interfere with the 
nutrition of the sclera, in consequence of which the tunica be- 
comes thin, blue and bulging, either in whole or in part, consti- 
tuting an Anterior staphyloma of the sclera and choroid, which 
again may terminate in suppuration within the globe, spon- 
taneous bursting and atrophy of the eyeball. 

THERAPEUTIC HINTS. — (Allen's and Norton's Ophthalmic 
Therapeutics). 

Aeon., acute stage; violent aching, dragging, tearing pains in 
the eyeballs; contracted pupils; photophobia. Eye sensitive to 
touch and feels hot and dry. After exposure to cold, dry air. 

Kalmia, sclera inflamed ; vitreous filled with opacities ; glimmer- 
ing of light below one eye, especially on reading with the other. 

Mercur., the sclera is thinned and blue ; aching in the eye all 
the time, but worse at night ; some pain around the eye if the iris 
has become involved. Flabby tongue, offensive breath, night 
pains ; syphilitic origin. 

Silic., pains severe, extending from the eyes to the head, relieved 
by wrapping up the head ; aching in the occiput corresponding 
to the eye affected. 

Thuja, has often shown itself useful in all forms of this affec- 
tion; the sclera becomes soft in consequence of extension of 
inflammation of the cornea and iris ; tenderness of the globe ; 
intolerance of light ; general cachectic condition, either scrofulous 
or syphilitic ; long deprivation of fresh air. 

Besides are recommended : Coccul., Pulsat, Spigel. and Sulphur. 

If in spite of these remedies staphylimatous degeneration of the 
sclera ensues, iridectomy must be made, unless still other remedies 
are found, to check this morbid process. 



IRIS. 
Iritis. 

Iritis is of frequent occurrence and is usually uncomplicated 
with inflammation of the neighboring tissues. It very rarely 
extends from the ciliary body and the choroid, but may extend 
to these structures. Tenderness of the eyeball to pressure is not 
marked in iritis, Unless the ciliary body is involved. 

Simple Plastic iritis is characterized by ciliary neuralgia, almost 






IRITIS. 159 

always worse at night, photophobia, lachryraation, dimness of 
vision, ciliary injection, chemosis, iris discolored, aqueous, hazy, 
sluggish, pupil contracted, and adhesion of iris to lens — posterior 
synechia. 

In Parenchymatous iritis the iris is more swollen and vascular 
with more exudation in pupil. 

In Suppurative iritis the lids are cedematous, there is more 
chemosis, and pus in the anterior chamber. 

In Syphilitic iritis we have secondary symptoms of syphilis and 
often gummata on the iris. 

Rheumatic iritis is like plastic, only the episcleral injection may 
be more marked. 

Traumatic iritis is like plastic. 

Serous iritis is characterized by a deposit of lymph on the pos- 
terior surface of the cornea, which takes a pyramidal shape with 
apex toward the centre of the cornea, cloudiness and hypersecre- 
tion of the aqueous humor, dilated pupil, deep anterior chamber 
and slight photophobia, lachrymation, ciliary injection. (Geo. S. 
Norton.) 

THERAPEUTIC HINTS.— "In the treatment of iritis Atropine is, 
I believe, of the greatest importance. The pupil must be kept 
dilated, or you are almost certain, in the great majorhVy of cases, 
to have serious results, as posterior synochia remaining after the 
inflammation has been subdued. Dry warmth and rest are also 
very important aids in the treatment." (Geo. S. Norton). 

Aeon., rheumatic form, after exposure to cold winds with great 
dryness and heat in the eye. 

Arnica, rheumatic and traumatic form. 

Arsen., burning pains worse after midnight, better from w r arm 
applications. 

Asaf., syphilitic form and after overdosing with mercury; 
severe throbbing, or burning, or sticking pain from within out- 
ward, better from rest and pressure. 

Aurum, syphilitic form and after the abuse of mercury and pot- 
ash ; pain in the orbital bones, pressing from above downwards, 
or from without inwards, worse on touch ; great mental depression. 

Bellad., rheumatic form; pressing pain around the eye, or 
stitching pain above or beside the eye, as if it were torn out or 
pressed in; pains come and go, with flashes* of light or dark 
spots with light margins, or dark fog before the eyes ; severe ver- 
tigo and headache even to loss of consciousness. 



160 iris. 

Bryon., rheumatic form; the pain is worse from moving the 
eyes and also in the evening and at night; there is shooting pain 
in the head, and pain as if the head should burst on stooping. 

Calend., traumatic iritis. 

Cedron, supra-orbital neuralgia, periodical. 

China, periodical pains; after loss of vital fluids and of malarial 
infection. 

Cinnab., syphilitic form; pain commences at inner canthus, ex- 
tending across the brow, or passing around the eye; nocturnal 
aggravation ; intermitting pain. 

Clemat, pressing pain in the eyes, photophobia and lachryma- 
tion, worse in the open air; heat in the eyes. 

Coloc, rheumatic form ; around the cornea a bluish-white ring ; 
photophobia; no lachrymation ; tearing pain in eye and sur- 
roundings; worse in the evening and at night. 

Conium, excessive photophobia without corresponding redness 
of eye. 

Euphras., rheumatic form ; aching and occasional darting pain 
in eye, worse at night ; iris adhering. 

Gelsem., serous form with choroidal exudation. 

Hamam., traumatic form with haemorrhage into the anterior 
chamber. 

Hepar, with corneitis or hypopion. Characteristics see in for- 
mer chapters. 

Kali jod., syphilitic form. After abuse of mercury. 

Mercur. and its various preparations, syphilitic and other forms; 
tearing, boring pains in the bones around the eyes; worse at 
night; sclerotitis and conjunctivitis; sweat without relief; bad 
smell from mouth; frequent spitting of saliva; tenesmus. 

Merc, corr., is commonly indicated by the symptoms of iritis more j 
than any other drug. (Xorton.) 

Natr. mur., pupil contracted; iris discolored; violent stitches 
in the temples on looking into the light or when the light is 
changed; on reading or writing the letters run together; sight 
much impaired. 

Nitr. ac, chronic syphilitic form with very little pain (Xorton) : 
also after abuse of mercury; pain worse on any change of tem- 
perature, at night and on touching the parts. 

Nux vom., rheumatic and syphilitic form; after drugging; pain 
worse in the morning. 

Petrol., syphilitic form with occipital headache. 



CHOROIDITIS. 161 

Pulsat, rheumatic form; pain worse in the afternoon and even- 
ing; cries easily and is -worse after crying. 

Rhus tox., rheumatic and traumatic form; lids swollen and 
spasmodically closed; lachrymation; conjunctiva chemosed ; pain 
worse at night; after getting wet; rainy weather; after Bryon. 

Silic, with hypopion and corneitis. 

Spigel., rheumatic form; excessive pain in and around the eye, 
especially on moving; sometimes periodically from morning till 
noon, and then abruptly ceasing. 

Sulphur, rheumatic and other forms; with hypopion; relapsing 
cases; psoric tendency; pain worse in the evening and at night; 
ears often affected. 

Tereb., rheumatic form ; after suppression of perspiration of the 
feet; urinary symptoms. 

Thuja, syphilitic form ; condylomata on the iris ; wart-like ex- 
crescences on the iris; pain better by warmth. 

Besides have been successfully employed: Arg. nitr., Crot. tigl., 
Hyosc, Iodum, Lycop., Plumbum, Stilling., Zincum. 

CHOROIDEA. 

The choroid is a dark brown vascular coat, which lies within 
and in contact with the sclera, and between it and the retina ; its 
proper structure terminates anteriorly where the ciliary body 
commences, which forms the connecting link between it and the 
iris. 

Choroiditis 

I is usually found uncomplicated with inflammation of other por- 
tions of the uveal tract. 

In Choroiditis disseminata the eyes feel weak and vision is blurred. 
The ophthalmoscope shows a yellowish-red nodule in the choroid 
in the first stage which soon atrophies, leaving a white spot sur- 
rounded by a rim of proliferated pigment. Other spots follow, 
and as they have a tendency to coalesce they form large atrophic 
plaques. The haziness of the vitreous is not marked unless the 
choroiditis is of the syphilitic variety when the haziness of the 
vitreous is a very prominent symptom, as is the non-tendency of 
the spots to run together. 

Choroiditis suppurativa (panophthalmitis) is usually the result 



162 CHOROIDEA. 

of foreign bodies or injuries and its course is generally rapid, 
destroying the eye. Characteristic symptoms are: oedematous 
swelling of the lids, chemosis, protrusion of the e} T e, hypopion, 
synochia posteriora, white reflex from the fundus, tension in- 
creased, eye sensitive to touch, loss of vision, very severe pain, 
fever and vomiting. 

Sclerotico-choroiditis posteriora or Posterior staphyloma is found in 
myopia, especially high degrees, and is characterized by a white 
crescent around the optic nerve entrance, especially outer side, 
which corresponds to the bulging of the sclera at that point. It 
may, however, be irregular and extend around the optic disc. 
When it is progressing the myopia increases, vision becomes 
more impaired, black, floating spots appear before the sight and 
the edges of the crescent are not as well defined. It is a congeni- 
tal trouble and is increased by overuse of the eyes. 

Cyclitis usually passes over into irido-cyclitis or irido-elioroiditis. 
A prominent symptom of irido-choroiditis is the increased tension 
in its early and diminished tension in its late stage." (G. S. Xorton). 

THERAPEUTIC HINTS.— Aurum., serous exudation between the 
choroid and retina; haziness of the vitreous; sensitiveness to 
light and touch; pressive pain in eye from above downward or 
from without inward; pain in the bones around the eye. After 
abuse of mercury or potash. 

Bellad., often indicated by congestion towards the head; eyes 
sensitive to light ; halo around the light ; various flashes of light, 
sparks, etc., before the eyes. 

Bryon., serous exudation ; following rheumatic iritis ; eyeball 
sore to touch and motion ; darting pains through the eye into 
the head. 

Gelsem., serous choroiditis ; iritic complications ; vision varies 
from day to day or from hour to hour ; sometimes fever, with 
thirstlessness. 

Kali hydroj., syphilitic origin ; disseminate variety. 

Merc. corr. or sol., disseminate form ; iritic complication ; syph 
ilitic dyscrasia ; tendency to adhesion ; nocturnal aggravation of 
the pains, both in and around the eye. 

Nux vom., after use of stimulants ; aggravation in the morning 

Phosphor., luminous appearance before the eyes, especially red 
after sexual excesses ; bright light, natural or artificial, hurts the 
eyes; they feel better in the twilight. 






GLAUCOMA. 163 

Prun. spin., with or without iritic or retinal complication ; severe 
pain in the eyeball, as if it were being pressed asunder, or else 
shooting and cutting pain through the eye and corresponding 
side of head, or crushing pain. 

Pulsat., when corresponding to the general disposition of the 
patient. 

Sulphur, chronic state ; sharp, darting pains ; after suppression 
of eruptions ; psoric taint. 

Besides, the following remedies have been useful : Aeon., Arsen., 
Coloc, Hepar, Ipec, Psorin., Ruta, Silic, Sol. nig. 

In Sclerotico-choroiditis posteriora has been found useful : 

Bellad., flushed face and throbbing congested headaches ; pho- 
tophobia. 

Crocus, pain from the eye to the top of the head ; also pain 
from left eye darting to the right ; sensation of cold wind blow- 
ing across the eyes. 

Mercur., usual indication. 

Phosphor., muscae volitantes, flashes of light before the eyes. 

Prun. spin., pains in eye as if pressed asunder, or sharp and 
starting, in and around the eye. 

Spigel., sharp, stabbing pains through the eye and around it, 
often commencing at one point and then seeming to radiate in 
every direction. 

Thuja, often called for in strumous and sycotic persons. 

Besides compare: Carb. veg., Kali jod*, Lycop., Physostigma, 
Ruta and Sulphur. 

In Choroiditis suppurativa compare: Aeon., Apis, Arsen., Hepar, 
Phytol., (traumatic origin, lids very hard, red and swollen ; con- 
junctiva chemosed and pus in the interior of the eye; severe 
pain). Rhus tox. is the most important remedy. Lids cedematous, 
much chemosis, photophobia and profuse gush of tears on open- 
ing the spasmodically closed lids, hypopion, pains at night, etc. 
(Norton.) Also : Asaf., Bellad., Mercur., Sulphur. 

In Hemorrhage compare: Arnica, Bellad., Cinchon., Crotal., 
Hamam., Laches., Phosphor., etc. 

Glaucoma. 

1. Acute form. — Its onset may for hours, days, weeks, months, 
even years, be premonitioned by one or the other, or several of 
the following symptoms: a halo, gray or colored, or a circle or 



164 CHOROIDKA. 

several in the same or different colors around candle light or lu- 
minous objects; flashes or wheels of light in the dark, as well as 
in the light, with or without intercurrent obscurations of sight ; 
periodic dimness of sight, or dimness of a part of the visual field ; 
rapid increase of presbyopia, ciliary neuralgia, headaches. The at- 
tack itself often commences suddenly with severe throbbing pain 
in the eyeball and the corresponding side of the head; the eyeball 
is very sensitive to touch ; flashes of a vivid red or deep orange 
color appear before the eyes with great photophobia, increased 
by exertion, or anything that quickens the heart's action, even 
the taking of food. The eyeball shows signs of inflammation 
in different degrees of intensity, such as : lachrymation and 
intolerance to light; swelling and redness of the eyelids; con- 
junctivitis with serous chemosis, but scarcely any purulent dis- 
charge; hypersemia of the sclerotica and congestion of the anterior 
ciliary veins; the cornea is hazy and a little roughened, or even 
vesicular in spots, or sometimes opaque interstitially ; its sensibil- 
ity is more or less lost in parts or in its entire structure. The 
iris loses its color, acquiring a slate-like aspect and is pushed 
against the cornea; the pupil becomes dilated, irregular and fixed; 
its color is less black than usual, but more of a drab color, show- 
ing sometimes even a shade of green. The eyeball, on palpation, 
feels harder than natural. The vision gradually grows duller, a thick 
fog appears before the eye in daylight and at night prismatic 
colors surround the candle light. The visual field usually com- 
mences to contract on the inner side and after a while all vision 
is lost. Ophthalmoscopic inspection reveals : haziness of the vit- 
reous body ; in hemorrhagic glaucoma, which is rare, there is 
hemorrhage either from the disc, the retina or the choroidea, 
singly or combined; excavation of ike optic disc, called glaumatous 
cupping, with dilatation of the retinal veins and pulsation of the 
central retinal arteries. 

2. The subacute form, or chronic glaucoma, shows all the symp 
toms above enumerated, only not so sharp and definitely marked, 
although leading in an insidious and slow manner to the same 
results. Glaucoma always begins in one eye. and is very apt to 
develop in the other, in the course of months or years. Its. causes 
have not been sufficiently explained and the nature of the glau- 
comatous tension of the eyeball is also not fully established. 

Post-mortem examinations have revealed : obliteration of 
Schlemm's canal (Kniess) ; closure of the drainage channels 



GLAUCOMA. 165 

(Weber); atrophy of the ciliary body, and atrophy or adhesion 
of the iris (Brailey), all of which are supposed to be more or less 
concerned in producing the increased tension of the globe. 

THERAPEUTIC HINTS— Iridectomy, first recommended by Dr. 
von Graefe, is by some considered as the only remedy worth 
speaking of, while other eye-surgeons recommend frequent tap- 
ping of the cornea, and the newest of all is sclerotomy. Whichever 
may be preferred or deemed necessary, in this I agree entirely 
with Walton, when he says: "Treatment by practical surgery 
alone is not enough ; it should be but a part, an auxiliary of a 
therapeutic system, embracing those details which help so much 
in subduing the abnormal conditions which are common to other 
affections and to glaucoma. I allude, of course, to the abnormal 
conditions of inflammation of the uveal tract, particularly cho- 
roiditis, to neuro-retinitis and hyalitis." (Page 1172.) 

Arg. nitr. See Advance, October, 1879. 

Aurum, pressure from within outward, and from above down- 
ward in eyeball ; heavy, dull aching of the globes ; upper half of 
an object invisible; showers of bright, star-like bodies appear in 
the upper dark section ; bright, floating streaks and dots in gas- 
light before the eyes. 

Bellad., pain in and around the eye, of a pressing nature, as if 
the eye were being pressed into the head, or sometimes as if the 
eye were being torn out ; the eyes feel hot, dry and stiff, as if 
they might protrude. 

Bryon., the eyes feel as if pressed out, often attended with sharp 
shooting pains through the eyes and head; they feel sore to 
touch and on moving them. 

Cedron., severe shooting pain along the course of the supra- 
orbital nerve. 

Coloc, severe burning, aching, sticking, cutting pain in the eye 
and around, always relieved by firm pressure, and by walking in 
a warm room, worse by rest at night and upon stooping. 

Eserine is much used at present and in some cases seems to act 
well. (Norton.) 

Phosphor., halo around the light, and various lights and colors 
flashing before the eyes, 

Prun. spin., severe crushing pain in the eye as if pressed asun- 
der, or sharp shooting through the eye and corresponding side 
of the head. 



166 OPTIC NERVE AND RETINA. 

Rhodod., periodic pain in and around the eye, worse before a 
storm and better after the storm commences. 

Spigel., sharp and stabbing pains through the eye and head, 
worse on motion and at night. 

Besides should be compared: Arnic, Arsen., Chamom., Coccul.. 
Collin., Conium, Crot. tigl., Gelsem., Hamam., Kali carb. and 
jod., Mercur., Nux vom., Phytol., Sulphur and Val. of Zinc. 

OPTIC NERVE AND RETINA. 

The optic nerve and the retina may, each of them, be the 
isolated seat of morbid derangement, the first usually from some 
cerebral disturbance, the latter from intra-ocular disorder; but 
either of them, if extensively affected, will also affect the other. 
We speak therefore of 

Neuro-Ketinitis 

as an inflammation of the optic nerve, the optic disk and the 
retina, a separation of which into different forms would be of 
little practical use. 

Its Subjective Symptoms are: haziness or fogginess in various 
degrees ; reduction of acuteness of direct and indirect vision ; 
contraction of the visual field ; blind spots in the visual field ; 
distortion of objects looked at; subjective appearances of light, 
so-called sparks, or flashes, or photopsia ; subjective play of colors, 
colored spectra, or chromotopsy; the latter two may occur even 
when the case has proceeded to absolute blindness. Still all these 
symptoms may occur also in various other intra-ocular diseases 
and the only sure way of making a diagnosis is with the oph- 
thalmoscope. 

The Ophthalmoscopic Symptoms are: optic disc swollen and 
outlines ill-defined, retina hazy and vessels veiled here and there: 
tortuous appearance of the veins which are dark and full ; usu- 
ally haemorrhage, most frequently observed in the retina, seldom 
in the disc ; occasionally whitish dots scattered in groups or dull 
glistening patches in the semi-opaque retina. There are no ex- 
ternal objective symptoms, unless other ocular tissues are drawn 
into the morbid process. It may lead to partial or complete 
atrophy of the retina. 

Its Causes are : Albuminuria, and then it is called Retinitis albu- 



NEURO-RETINITIS. 1G7 

minurica; haemorrhage into the retina and white spots here and 
there, especially of a stellate arrangement in the macula lutea are 
characteristic and early symptoms of this form. iSyjiliilis, and 
then it is called Retinitis syphilitica ; it can be diagnosed only by 
the precedence or presence of some other mark of constitutional 
syphilis. Diabetes, and then it is called Retinitis diabetica, with 
similar appearance as retinitis albuminurica ; Leucaemia (Retinitis 
lencasmica) ; great pallor of the retinal vessels; hemorrhages in 
retina( Retinitis apoplectica) ; deposits of pigment in retina (Retinitis 
pigmentosa); contraction of field of vision, night-blindness and 
deposits of pigment in retina extending from periphery to centre 
of fundus. Direct and reflected rays of artificial light or of the 
sun, and overstraining the eyes under imperfect or unsteady 
light, also traumatic injuries. 

There are other affections of the optic nerve and of the retina 
which too may cause impairment of sight or even total blindness, 
without showing externally any objective symptoms. Such affec- 
tions were, before the ophthalmoscope was known, classed under 
the terms Amblyopia (impaired sight) or Amaurosis (what renders 
obscure, dark). These terms have of late been stricken out of the 
books, because where there is impaired sight or loss of vision 
there can now, by the use of the ophthalmoscope, be found also a 
corresponding change in the optic nerve or retina, a pathological 
cause of amblyopia or amaurosis, from which the affection 
receives its proper name. 

THERAPEUTIC HINTS.— Aeon., total blindness produced sud- 
denly by taking cold. 

Ammoniacum, after severe blows upon the head, sight impaired ; 
smoke before the eyes, shaping in different circles, most distinctly 
on white ground ; the margins of the circles are gray and become 
black upon sudden motions of the eye; better in clear, worse in 
cloudy weather ; persons in a distance he cannot recognize ; by 
candle-light their faces appear dark. 

Apis, albuminuria, after scarlet fever. 

Arnica, after a violent blow, loss of sight. 

Arsen., after abuse of liquor and tobacco ; urine scanty and 
albuminous. 

Aurum nrar., after scarlet fever and during childbed (albumi- 
nuria) ; sudden loss of vision, with cold perspiration, small pulse, 
quick and irregular breathing. 



168 OPTIC NERVE AND RETINA. 

Bellad., optic disc swollen and outlines ill-defined, retinal ves- 
sels large and tortuous, blue and bluish-gray film seems to cover 
fundus. (Norton.) Haemorrhage of retina, with suppression of 
menses ; cerebral congestion ; sudden heat of head ; vertigo, 
burning and throbbing pain; noises in ears and illusions of 
vision, while the rest of the body is cold and shivering ; pulsation 
of carotids. After suppressed scarlet eruption. 

Bryon., eyes feel full and sore on motion or to touch. 

Cactus, with heart troubles. 

Cinchon., sudden blindness with violent pain in occiput, extend- 
ing into the eyes ; irritability of entire spine ; spleen swollen and 
painful to pressure ; rumbling in the abdomen ; sour vomiting ; 
constipation. 

Crotal., haemorrhages in retina. (Norton). 

Gelsem., thirst for light ; after apoplexy, congestion to the head ; 
albuminuria during pregnancy, after diphtheritis. 

Kali hydr., syphilitic form. 

Laches., haemorrhage of retina ; albuminuria. 

Merc, corr., albuminuric form, especially during pregnancy. 

Merc, sol., sensitiveness of the eyes to the glare of a fire. 

Nux vom., abuse of stimulants and tobacco. 

Phosphor., photopsies and chromotopsies, as halo around the 
light ; dryness of the nose ; after sexual excesses. 

Pulsat, "choked disc," great swelling of optic papillae and en- 
largement of vessels ; vision nearly lost, with severe headache, 
only relieved in the open air. (Norton). Menstrual difficulties. 

Secale, photophobia ; suppressed secretion of tears ; stitching 
pain in the eyes ; dilated pupils ; blue and fiery dots flying before 
the eyes. 

Sulphur, suppressed itch. 

For impaired sight (amblyopia) and blindness (amaurosis) the 
following remedies also have been found useful: Alum., Baryta 
carb., Bovista, Calc. carb., Chelid., Crotol., Cyclam., Elaps, Hepar., 
Ignat., Kali acet., Lycop., Natr. mur., Ruta, Santon., Sepia, Thuja, 
Zincum. 



He miopia, 

Or half vision, is a contraction of the visual field, either on the 
two right or on the two left sides of the eyes, in consequence of 
an affection of either the right or the left optic nerve tract before 



HEMIOPIA — HEMERALOPIA — HYPERESTHESIA RETINA. 169 

the crossing at chiasm ; blindness of the opposite sides of each 
retina, occurs when the optic nerve fibres are disturbed at the 
chiasma, that is at the point where the nerve fasciculi cross each 
other. Upper half blindness denotes an insensibility of the lower 
portion of the retinal nerve fibres, and is usually dependent upon 
a detachment of retina or embolism of branch of central retinal 
artery. Scotomata, or blind spots, are insensibility of certain cor- 
responding parts of the retina. 

THERAPEUTIC HINTS.— Upper half blindness : Aurum, Digit., 
Phosphor. ; right half blindness : Cyclam., Lith. carb., Lycop. ; 
half vision either side : Bovista, Calc. carb., Caustic, Chin, sulph., 
Lob. infL, Lycop., Mur. ac, Natr. mur., Sepia, Viol. od. 

Hemeralopia, Night-Blindness. 

The patient sees well enough, as long as there is enough stimu- 
lus of bright light ; but he cannot discern objects any more, as 
soon as the amount of light required by him is withdrawn; be it 
daylight or candle-light. It is most common among sea-faring 
men. The glare from the sea seems to be the exciting cause 
added to some constitutional weakness ; but it is also found occa- 
sionally with harvesters and soldiers, where fatigue and exposure 
to the glaring sunlight seem the elements in its production. 

THERAPEUTIC HINTS.— Cases have been cured by: Arg. nitr., 
Bellad., China, Hyosc, Lycop., Pulsat, Ran. bulb., Stramon., 
Sulphur, Veratr. 

Hyperesthesia Retinae. 

We understand by it an oversensitiveness of the optic nerve 
and retina ; even a small amount of light cannot be borne and 
sometimes its impression lasts too long. This may be caused by 
irritation of the optic nerve and retina, with or without ciliary 
irritation. Ciliary irritation is usually accompanied by lachry- 
mation and pain in the eyeball, and associated with many affec- 
tions of the cornea and conjunctiva; this affection is usually 
spoken of as Photophobia. When the overexcitement of the 
optic nerve and retina does not • depend on external conditions, 
we have, with or without intolerance to light, subjective appear- 



170 LENS. 

ances before the eyes, such as sparks, bright white, or colored 
patches, flames, colored rings, chromatic clouds, so-called phos- 
phenes, also known under the name of Photopsia and Chromotopsy ; 
and in some instances a too long duration of the impressions, 
especially from bright objects, which continue to affect the optic 
nerve even after the eyes have been turned to some other object, 
whereby confusion arises and the objects seem to dance. 

THERAPEUTIC HINTS.— For this affection a great number of 
remedies may present themselves for consideration. We shall 
have to weigh carefully all the symptoms of the case. Perhaps 
one or the other of the following may be indicated : Aeon., Bellad., 
Cinchon., Conium, Gelsem., Hepar, Hyosc, Ignat., Lact. ac.,Merc. 
sol., Natr. mur., Nux vom., Phosphor., Pulsat., Sulphur, Tart. em. 

LENS. 
Cataract, 

Is loss of transparency of a part or of the whole, either of the 
crystalline lens (lenticular cataract), or of the capsule (capsular 
cataract), or of both (capsulo-lenticular cataract). 

In the course of physiological development the lens commences 
to change after the age of about thirty-five years to greater 
density, more coloration and loss of convexity, and in the senile 
eye the pupil has lost its blackness, appears cloudy or of a light 
amber tint, or brownish yellow, yet without loss of transparency. 
This ought to be borne in mind. The cataractous changes are 
different. Consisting in atrophy from loss of nutrition, the lens 
fibres are converted into different solid and fluid materials ; the 
nucleus becomes hard and dry, while the cortex may be soft- 
ening to the state of a semi-fluid pulp, with remains of opaque 
fibres, molecular substance and fatty tissue, especially in its 
hy ermature state. This is the nature of the so-called Hard 
cataract. The Soft cataract consists of a conversion of the lens 
tissue into a paste-like material, or a degeneration of it into a 
soft substance of a thin milk-like color with granular flocculi, 
corpuscles and fatty material. The former is the cataract of 
adults, elderly and old people ; the latter is met with from birth 
to puberty. 

The cataractous changes of the capsule are probably the result 



CATARACT. 171 

of inflammatory action ; they are mostly attended by a secondary 
degeneration of the lens, or vice versa accompany a fluid degen- 
eration of the lens. In Traumatic cataract, which originates in 
consequence of a blow or other external injury to the eye, the 
capsule is nearly always opaque, and the cataract is of the soft 
kind ; in the uncomplicated cataract of the aged, however, it is 
seldom altered. 

The Objective Symptoms of these different affections can 
clearly be elucidated only by the ophthalmoscope. They are im- 
portant to the eye-surgeon, who will consult special works thereon, 
but even the naked eye is capable of detecting opacities of the lens. 
The following are the Subjective Symptoms: As soon as the opac- 
ity upon either the lens or the capsule is dense enough, to interfere 
with the rays of light, the first symptom is indistinctness of sight 
or mistiness ; at first distant objects are seen as if through a mist 
or fog, or a bit of glass that had been breathed on ; after awhile 
this mistiness envelopes near objects also. The adjusting power 
is lessened, because of the lens losing its elasticity. The 
patient now sees better in twilight ; then the pupil expands and 
more rays are allowed to pass through the lens. For this reason 
the patient shades his eyes in bright light and derives benefit 
from wearing goggles. In some cases there is even intolerance 
to bright light. Tn other cases the objects appear doubled or 
even farther multiplied, and are seen in fantastic forms. This 
arises when portions of the lens still remain transparent, but vary 
in the degree of their density, whereby an irregular astigmatism 
is produced. Muscee, of all shapes and sizes, and sometimes in 
showers are of frequent occurrence ; but flashes, stars, fiery circles, 
bright metallic light, bright spectra like silver must be attributed 
to other diseases of the eye ; they have nothing to do with the 
cataractous affection of the lens. 

Causes. — "Defective nutrition," merely expresses, in other 
words, what cataract consists of, but does not tell the cause which 
in fact we know not. We can merely state, that cataract has 
been observed to develop : after external injuries of the eye ; in 
consequence of diabetes ; after fever ; in consequence of other 
diseases of the eyes, either active or of a low type ; in consequence 
of hereditary influences. After one eye has been attacked, the 
other is likely to follow. 

THERAPEUTIC HINTS.— Under certain circumstances the best 



172 SIGHT. 

and quickest relief can be afforded only by an operation, but 
there is no doubt that homoeopathic treatment has succeeded not 
only in checking further development, but also in clearing up 
existing opacities of lens and capsule. The following are the 
most important remedies : 

Amnion, carb., (right eye) ; Baryta carb. ; Bellad., (after acute in- 
flammation of the eye); Calc. carb., (scrofulous individuals) ; Cannab.; 
Caustic, (constant inclination to touch and rub the eye, which 
seems to relieve a pressure in it); Contain, (old persons); Euphras., 
after Sulphur, (congenital cataract); Lycop., (after typhus; sup- 
pressed menses) ; Magn. carb., (from left to right ; previous disposi- 
tion to headache and furuncles) ; Phosphor. ; Saccharum Sacchari, 
(in several cases of old age) ; Sepia ; Silic, (after inflammation of 
the eye ; preceding ringworms ; suppressed sweat of feet) ; Sulphur, 
(from right to left ; after cutaneous eruptions, especially suppressed 
itch. According to Jahr main remedy). 

"Dislocation of the lens often results from injury and may be 
spontaneous. It is most commonly dislocated backward into 
the vitreous, though it may lie in the anterior chamber or even 
under the conjunctiva. The lens may be seen in any case lying 
in its unnatural position. When in the vitreous, the tremulous 
condition of the iris will call attention to the trouble." — (Geo. S. 
Norton). 



SIGHT. 
Refraction and Accommodation. 

A luminous body sends off rays of light in all directions, and 
in whatever direction tbey go they always move in straight lines, 
unless interfered w T ith by a medium of different density. When 
entering a lens they are bent towards its thicker portion ; a bi- 
convex lens converges them to a focus; a biconcave lens scatters 
them for the same reason. Now when parallel or even slightly 
divergent rays of light from an object enter the pupil, and pass 
through the crystalline lens of the eye, they are bent by this 
body towards its thicker part and are thus focussed upon the 
retina. In this bending and gathering of the rays of light to a 
focus upon the retina consists what is technically called the 
Refraction of light. It is a purely mechanical process conditioned 
by the transparency and biconvexity of the lens, which like any 



REFRACTION AND ACCOMMODATION. 173 

other biconvex lens, focusses the parallel and divergent rays of 
light at a certain distance, according to the amount of its con- 
vexity, that is according to its refractive power. When an object 
is sufficiently near the eye to emit divergent rays, it is said to be 
at a finite distance; when, however, it is sufficiently far away to 
emit parallel rays of light to the eye, it is spoken of as being at 
an indefinite or indeterminate distance. In either case the rays 
are not entirely and equally parallel, and consequently the focus 
must vary in its distance behind the lens, either fall in front of, 
or behind the retina. 

Only if an object were brought in the exact position from 
which its rays could be focussed upon the retina, it could be 
seen distinctly. We know, however, from experience, that for a 
normal eye such exact position of objects as to distance, in order 
to see them, is not required. The healthy eye possesses a faculty 
by which it brings both parallel rays and rays in various degrees 
of divergency, to an accurate focus upon the retina; it sees 
clearly and distinctly at different distances, adapting itself for 
the position of the object looked at; and this is called its power 
of Accommodation or Adaptation. The nearest distance to the eye 
at which a small object can be seen distinctly by the maximum 
of accommodation, or by its greatest effort to see, is termed "the 
near point of vision ;" the farthest distance at which anything 
can be clearly discerned, is "the far point of vision." These 
points vary in different eyes ; the interval between the near and 
the far point is termed the range or territory of accommodation. 

Now the question arises, How is this accommodation of the eye 
to the various distances of objects effected? As the lens is only 
a passive agent of refraction, and as upon its form depends the 
distance where the transient rays are focussed, we must look for 
the means by which this change in the form of the lens is 
effected. And here all the latest researches agree in this, that 
the constant variations in the curvings of the lens, as accommo- 
dation for near and far objects requires, are brought about by 
the ciliary muscle of the eye. 

Associated with this ever-changing form of the lens by means 
of the ciliary muscle are also pupillary movements — contraction for 
near objects to cut off the lateral rays of light, and dilatation for 
distant objects, the sphincter pupillse and the ciliary muscle 
being in a functional connection by nerve-fibres ; and to this may 
be added the action of the recti muscles, which in accommodat- 



174 SIGHT. 

ing for near binocular vision, turn the eyeballs inwards, while 
for perceiving distant objects, they place them parallel. 

Presbyopia, or Old Sight. 

The constant change in the curvings of the lens, as accommo- 
dation requires, can readily be effected only so long as the lens 
is sufficiently soft and yielding. As, however, the lens in the 
course of years grows denser and therefore less capable of being 
acted on by the ciliary muscle in the process of accommodation, 
and as also its shape becomes natter and in consequence its re- 
fractive power reduced — the near point of vision gradually re- 
cedes, that is to say : If we were able all along to see an object 
distinctly at a distance of four or five inches, etc., because of the 
greater convexity to which the lens could be shaped by the cil- 
iary muscle for such purpose, we now have to hold the same ob- 
ject further off, in order to receive a distinct visual impression, 
showing that the lens is not capable any more of being shaped 
convex enough to gather the divergent rays of the near point to 
a focus upon the retina. The near point of vision has receded to 
eight, twelve or sixteen inches. "Withall this, distant objects are 
discerned as accurately as before. This is Presbyopia — a diminu- 
tion of accommodation for near objects, with diminution of re- 
fraction, consequent on age. 

This natural change in the crystalline lens commences in early 
life and gradually increases with advancing years. Generally 
about the age of forty, the near point is eight inches from the 
cornea, and at about forty-five years it recedes to twelve or six- 
teen inches. In some instances the change sets in suddenly, so 
that a month or even a week will make all the difference in the 
condition of the eye. In such cases we should bear in mind that 
a rapid increase of presbyopia is also a prominent symptom of 
glaucoma. Still later the far point for distinct vision, too, declines, 
and the focal range is thereby lessened. With the loss of range, 
there may be loss of acuteness of vision, arising from retinal ob- 
tuseness. Presbyopia requires convex glasses, which ought to be 
changed as often as the progress in the change of the crystalline 
lens demands it. Lenses will not afford any help to distant 
vision, unless there be hypermetropia combined with it. 



HYPERMETROPIA — MYOPIA. 175 

Hypermetropia. 

This affection is caused by a congenital, often hereditary mal- 
formation of the eyeball, which is smaller than in the emmetropic 
eye ; its antero-posterior diameter is shorter than that of a nor- 
mal eye, consequently the parallel rays of light entering the pupil 
do not unite and form a focus on the retina, but fall behind it, 
and were the sclerotica removed posteriorly, they would converge 
to a point behind its boundary. Therefore, it is still farther im- 
possible for divergent rays to be properly refracted for the func- 
tion of sight. Only rays that have been artificially rendered 
convergent by a convex lens, are properly focussed upon the 
retina. 

Slight degrees of this affection are often masked by the great 
accommodating power of the lens during youth ; an abnormally 
distant position of the near point, however, in young persons 
may be taken as a very conclusive evidence of the presence of 
hypermetropia; after manhood the marked removal of the near 
point, the loss of acuteness of vision, the very decided assistance 
afforded to far vision by a convex lens, and the strong glasses 
needed for seeing small type confirm its presence. 

"In hypermetropia, asthenopic symptoms, as: eyes tire easily, 
blurring of vision, aching in and over the eyes, etc., after using 
for near work, occur early and require immediate selection of the 
proper convex glass." (Norton). 

Myopia, or Short-sightedness, 

Is the opposite condition to hypermetropia. The antero-poste- 
rior diameter of the eyeball is longer than in the emmetropic or 
normal eye, hence distant or parallel rays of light are brought to 
a focus before they reach the retina and the image which is 
formed on the retina is blurred and indistinct. Only divergent 
rays, that is, rays coming from near objects, are accurately fo- 
cussed on the retina. While, therefore, the myopic eye can see 
near objects, it cannot see distant ones well without optical aid. 
The myopic far-point is always at a definite distance; in bad 
cases it may be within a few inches of the cornea ; there is in 
such cases little difference in the distance between it and the near 
point, The two are in proportion to each other, the further the 
far-point, the further also the near-point and vice versa. 



" Myopia may be produced by a spasm of the ciliary muscle 
and must not be confounded with an elongation of the antero- 
posterior axis." (Norton). 

The disposition to myopia is almost invariably congenital and 
hereditary; it is, therefore, a most uncommon occurrence for 
myopia to appear after the fifteenth year of age, and it is never 
acquired after the twentieth in eyes that are normal. 

Its development is favored by the tension of the eye, which is 
inseparably connected with looking at near objects where, by the 
constant and strong action of the internal recti muscles to pro- 
duce the necessary convergence of the optic axis for the requisite 
position of the corresponding portions of the retinae, the eyeball 
gradually is drawn into a more or less oval shape, which finally 
may amount to the formation of a posterior staphyloma by atro- 
phy of the choroid and sclerotica. Myopia is, therefore, essen- 
tially an accompaniment of civilization, where it prevails chiefly 
among those classes who, from childhood on, have had to use 
their eyes continuously in reading and writing or other close 
work. 

In old age, when the lens grows flatter (see Presbyopia) the 
near-point recedes and consequently the myopic can often read 
again without the aid of glasses. This gain in sight is not an 
actual improvement of the eye ; its myopic defect remains the 
same, but the flattening of the lens by age lengthens the focal 
distance which now reaches the retina. The myopic eye can be 
relieved by concave lenses, which ought to be selected carefully 
and not used too strong. 

Astigmatism. 

" The term astigmatism is used to express a state of sight re- 
sulting from want of symmetry in the anterior portion of the 
eyeballs. The rays of light do not unite by convergence and 
form in a regular manner in one point or focus on the retina, 
but reach it partially or irregularly, some of them coming to a 
focus in front of it, or not forming any focus, whereby circles of 
dispersion or diffuse images fall on the retina, and indistinctness 
of vision is produced." (Walton.) This irregularity in focaliz- 
ing the rays of light is mainly due to assymmetry of the cornea, 
and in some cases also to that of the lens. The patient usually 
holds objects close to his eyes, as a myopic; the lines of adjoining 



ASTIGMATISM ASTHENOPIA. 1 i i 

letters seem to cover each other; parallel lines in different direc- 
tions, one set for instance being vertical and another horizontal, 
do not appear equally distinct but blurred ; things at a distance 
are sometimes seen double, and a square figure will have the ap- 
pearance of an oblong; in high grades of astigmatism there is 
chromatic aberration, so that luminous objects sometimes appear 
surrounded by variously colored borders. Astigmatism may be 
combined with myopia or hypermetropia. It is often hereditary 
or may be caused by the removal of the pupil from its central 
position either from accident, disease or in consequence of an 
operation ; by the slightly irregular manner in which the cor- 
neal flap may heal after an operation for the extraction of cata- 
ract ; by the irregularity in the corneal curves produced by in- 
flammation of the cornea; by the dislocation of the crystalline 
lens from accident or disease. 

Its remedies are carefully selected cylindrical glasses, and in 
case of inflammatory diseases of the cornea or traumatical causes, 
carefully selected medicines. Compare Corneitis, etc. 

Asthenopia. 

"This may be defined to be inability to maintain the adjust- 
ment of the eye for short distances, for a sufficient period without 
fatigue." (Walton). The asthenopic eye gets tired when em- 
ployed any length of time in reading, writing or other close work, 
especially by insufficient or artificial light; the ciliary muscle, 
which is the muscle of accommodation, cannot stand the strain 
required by the smallness of the objects and the close approxi- 
mation of the eyes to them ; it relaxes and the crystalline lens 
flattens, whereby the focus from the objects is changed and the 
objects become indistinct and blurred. A little rest relieves it 
all; the ciliary muscle is ready again for shaping the lens to the 
necessary convexity — but soon gives out again. At last a pressure 
and fulness is felt in the eyes and a tension and pain in the 
forehead; sometimes the pupils become contracted and the con- 
junctiva reddened. The cause of all this is want of sufficient 
refraction in the eyeball, which is principally found in a hyper- 
metropic formation of the eye, and therefore there is a close 
relationship between the two affections ; in pure forms of astheno- 
pia, according to Walton, hypermetropia is never absent. This 
form is called Accommodative asthenopia. Asthenopic symptoms 

12 



178 SIGHT. 

will also occur when the ciliary muscle, in consequence of illness 
or exhaustive diseases, becomes paretic, or when the internal 
recti muscles, from relative or absolute deficiency of power, can- 
not maintain the proper convergence of the eyes for near sight; 
this is called Muscular asthenopia. The accommodative form 
depends chiefly on the degree of the existing hypermetropia ; it 
may develop itself at the early age of ten. The muscular form 
depends more on general conditions of the system, and as excit- 
ing causes may therefore be mentioned for the first: long-con- 
tinued application of the ej r es to close work, especially by insuffi- 
cient light; and for the second: general debility; mental troubles ; 
dissipation, etc. 

THERAPEUTIC HINTS.— The accommodative form requires con- 
vex glasses for the relief of the existing hypermetropia; the 
muscular form also needs correction of the usually existing ano- 
maly of refraction by suitable glasses. A study of the general 
state of the debilitated system will be required for the selection 
of the corresponding remedy. 

Aeon., eyes hot and dry from overuse ; relieved temporarily by 
cold water. 

Apis, stinging pain and lachrymation. 

Arg. nitr., blepharitis ; hypermetropia and weakness of the cili- 
ary muscle. 

Calc. carb., fatigue and pain from using the eyes; on looking at 
near objects they become indistinct and blurred; general Calcarea 
symptoms. 

China, debility after exhausting sickness. 

Cina, spasmodic twitchings of the orbicular muscle; twitchings 
in the muscles of the face ; from intestinal irritation by worms or 
otherwise; after masturbation. 

Cinnab., pain from inner canthus, extending above and around 
the eye. 

Conium, cannot bear bright light or heat. 

Euphras., blurring of vision relieved by winking. 

Gelsem., especially in the muscular form from weakness of the 
external rectus. 

Ignat, nervous, hysterical females; onanism. 

Jabor., asthenopic symptoms, especially dependent upon an 
irritable condition of the ciliary muscle. (Norton). 

Lilium, pain in forehead ; photophobia ; blepharitis ; astigmatism. 



MYDRIASIS. 179 

Natr. mur., stiff and drawing sensation in the muscles upon 
moving the eyes; the eyes smart, itch and burn; feel best on 
being kept shut and pressed upon ; muscular form. 

Nux vom., after dissipations. 

Phosphor., dull pain deep in the eyes; black spots before the 
eyes, especially when looking at bright objects and by artificial 
light ; better in twilight. 

Rhodod., weakness of internal recti ; darting pains through head 
and eyes, worse before a storm. 

Rhus tox., after great strain of the eyes ; muscular form. 

Ruta, aching in and over the eyes after straining the eyes at 
fine work ; heat in the eyes and lachrymation after close work ; 
accommodative form. 



MUSCLES AND NERVES. 

Mydriasis. 

This is a dilatation of the pupils. The iris is chiefly composed 
of non-striated muscular fibres, arranged in a circular and in a 
radiating direction. The circular fibres are supplied by the third 
nerve, and act as a sphincter pupillae, while the radiating fibres 
are supplied by the sympathetic nerve, and increase the aperture 
when stimulated to contract. Mydriasis may therefore be caused 
either by a paralysis of the third nerve or by stimulation of the 
sympathetic. One of the differences between the two is, that 
with the paralysis of the third nerve there almost always is asso- 
ciated a paralysis of the ciliary muscle, which more or less de- 
stroys the power of accommodation. Its exciting Causes may be 
either peripheral, from exposure to cold winds, blows, etc., or 
cerebral, in consequence of effusion into the ventricles of the 
brain, concussion of the brain, basilar meningitis, diseases of the 
cerebellum, apoplectic effusions at the base of the brain, glaucoma 
and certain narcotics. 

Myosis 

"Is a persistent regular contraction of the pupil below its medium 
size, with immobility and without change of structure in the iris 
or in the eye." (Walton). It is caused either by a paralysis of 
the sympathetic nerve or by an irritation of the third. In the 



180 MUSCLES AND NERVES. 

first case there probably are diseases of the neck, or in the spinal 
cord, which involve the cervical sympathetic, at the bottom of the 
trouble; in the latter case the cause lies in morbid conditions of 
the brain, which irritate the third nerve. 

Special THERAPEUTIC HINTS cannot be given. Mydriasis, as 
well as myosis, are mere symptoms of other more deeply seated 
disorders, which must be studied accordingly. Our repertories 
show a number of remedies for both of these symptoms. 

Ptosis, or Falling of the Upper Eyelid. 

This affection may be due : 1st, to a paralysis of the levator pal- 
pebral muscle, which is under the control of the third cerebral 
nerve ; 2d, to a loss of muscular power in the levator, consequent 
on age; 3d, to a falling of the eyebrow, in consequence of paraly- 
sis of the occipito-frontalis muscle; 4th, to a congenital deficiency 
of the levator palpebral; 5th, to a hypertrophy of the palpebral 
integument; or, 6th, to chronic ophthalmia with granular eyelid. 

THERAPEUTIC HINTS.— The most frequently indicated remedies 
are : Caustic, Gelsem., Hyosc, Nux vom., Plumbum, Rhus tox., Sepia and 
Zincum. A congenital deficiency of the levator palpebral cannot 
be reached by any medicine. For granular eyelid, compare the 
corresponding chapter. 

Strabismus, or Squint. 

" Strabismus is a deviation of the visual axes. The axis of the 
one eye being directed to the object desired to be seen, while that 
of the other is turned too much inwards, {internal squint) or out- 
wards (external squint)." (Walton.) 

Internal squint is the most frequent of the two. It may arise 
from more or less paralysis of the external rectus, generally of the 
one eye, exceptionally of the two; or from some functional change, 
some shortening, at first dynamically, afterwards at a varying 
period, organic shortening, with or without hypertrophy of the 
internal rectus; from lesion of the brain or of the ocular nerves 
in cases of inflammation, softening, apoplexy, hydrocephalus, 
scrofulous tubercles, epilepsy; from intestinal irritation by worms; 
during teething; from visual defects, in consequence of inflam- 
mation within the eye or of the cornea; from diseases which 



STRABISMUS — NYSTAGMUS. 1S1 

damage the function of the external rectus, such as tumors, trau- 
matic or specific inflammations, abscesses, neuralgia. Its most 
frequent cause is hypermetropia. 

The External or Divergent squint seldom appears before puberty, 
except in connection with a diseased brain. It mostly arises 
from some form of impairment of vision affecting either one or 
both eyes, or from a difference in the refraction of the two eyes> 
or some disparity between them in the function of sight, all of 
which is commonly associated with myopia. Its direct cause in 
most cases is paralysis of the motor oculi nerve. The external 
rectus muscle is influenced in the same way by effusion in the 
orbit, tumors and all mechanical lesions of its muscles, and by 
cerebral disorders like the internal muscle in inward squint. 

THERAPEUTIC HINTS.— Cerebral irritation with corresponding 
symptoms require: Agar., BeUad., Cicuta, Gelsem., Hyosc., Nux vom., 
Stramon., Sulphur. 

Alum., recommended by Jahr if Bellad. and Hyosc. have failed. 

Cicuta, after convulsions. 

Cale. carb., after ophthalmia, or overstrain by close work ; stru- 
mous subjects. 

Cyclam., after unsuccessful operation; after convulsions, or 
measles. 

Intestinal irritation from worms or other causes require: 

Cina, picking of nose; restless sleep; grating of teeth; short 
hacking cough through the night. 

Cyclam., see above. 

Sepia, nocturnal enuresis during first sleep. 

Spigel., itching at the anus. 

Sulphur, nightly itching of the skin; cutaneous eruption; con- 
stipation. 

Suitable glasses may be of great help. 

Surgical operation is required where there is an organic short- 
ening of the internal or external rectus; paralytic squint is least 
benefited by it, and in mere nervous disturbance it is not called 
for at all. 

Nystagmus, Trembling of the Eyeballs. 

It is an involuntary, rhythmical motion of the eyeball, mostly 
from side to side, sometimes in an oblique direction, without im- 



182 MUSCLES AND NEKVES. 

pairment of the muscular movements. These oscillatory motions 
are nearly always permanent during the waking hours, but do 
not interfere with the simultaneous action of the two eyes; some- 
times they are associated with internal squint. The disease 
nearly always arises in infancy, and is frequently seen in connec- 
tion with congenital cataract, or other states of the eye which 
impair sight. It is common to the Albinos, when there is an 
absence of the pigmentum nigrum. Although ascribed to a 
morbid condition of innervation, its true nature is unknown. 

Luscitas, or Fixed State of the Eyeball, 

Is limited or lost power of movement of the eyeball, which re- 
mains in a fixed position either with or without deviation from 
the orbital axis, and cannot in any degree follow the movements 
of the other eye. Luscitas is a symptom either of paralysis of the 
third nerve, when the eyeball is turned outward by the abductor 
muscle, or of paralysis of the abductor, when the eyeball is turned 
inside — all consequences of brain-disease, chronic hydrocephalus 
especially. Bat external causes, such as injuries to the muscles 
of the orbit or to their nerves, tumors, staphylomatous enlarge- 
ments of the sclerotica, may also fix the eyeball in any direction. 

Morbid Winking 

Is a clonic spasm of the orbicularis palpebrarum muscle, and fre- 
quently found in connection with severe conjunctival irritation; 
sometimes it is of constitutional origin. 



Twitching of the Eyelids, or Quivering, 

Nearly related to the above, may effect one lid or both. It some- 
times is so slight that it cannot be seen, but may plainly be felt ; 
although annoying, it seldom is attended with pain, and is 
usually the consequence of deranged digestion or feebleness from 
overwork. 



Blepharospasm. 

The eyelids are violently and persistently closed. It is nearly 
always associated with intolerance of light and discharge of tears. 



NEURALGIA OF THE EYE. 183 

Its sources are various. They may arise in the eye itself, or 
in other organs, and transmit their influence to the brain at 
the origin of the portio dura, through the fifth nerve, the optic 
the vagus, the sympathetic, or directly from cerebral disturbance. 
Thus we see it produced by trichiasis, strumous conjunctivitis, 
corneitis, retinitis; carious teeth, supra-orbital neuralgia; a blow 
on the head or other injury; hysterical irritation. It may affect 
one or both eyes, it may last a long time uninterruptedly or in 
spells ; it may be associated with spasm of the facial muscles. 

THERAPEUTIC HINTS.— Nystagmus— Hyosc. ? 

Morbid winking has been relieved by Agar, and Ignat. 

Twitching by Cina, Physost. 

Blepharospasm by Bellad., Viola trie, Symphitum (after a blow), 
and other remedies, which must be selected according to the 
individual state of the patient. Compare the chapters which 
treat of its sources. 



Neuralgia of the Eye. 

It is usually an affection of the ophthalmic and superior maxil- 
lary division of the fifth cranial nerve, which supply the eyeball 
the ocular appendages, and the circum-orbital region. One or the 
other of the branches of these nerve-trunks may be affected. Most 
frequently we find it located in the upper eyelid, the middle of 
the eyebrow, the nasal extremity of the superciliary arch, the 
inner canthus or the temple; or it follows in the direction of the 
supra and infra-orbital nerves; or it is entirely intra-ocular 
without any affection of the nerves radiating from the orbit. 

The first of these varieties is often intermittent or remittent 
and may become chronic; it may alternate with nervous pains in 
other parts of the body. The Causes are frequently obscure, often 
however traceable to malarial influences or exposure to cold. 
The second variety may arise out of the effects of the fangs of 
carious upper back teeth. When the pains are deep-seated, its 
origin is intra-orbital or even intra-cranial and may arise from 
thickening of the dura mater, orbital or cranial exostoses, aneu- 
risms or tumors. 

THERAPEUTIC HINTS.— These different forms and causes show 
that not a few remedies may present themselves for our considera- 



184 ORBIT. 

tion. However, to avoid repetition, I refer to the chapter on 
neuralgia of the face. 

ORBIT. 

Orbital Cellulitis. 

" Inflammation of the orbit is usually severe and acute in 
character; is marked by great swelling of the lids, extensive 
chemosis, protrusion of the eyeball and intense pain in and 
around the eye, aggravated on any movement of the eye. Move- 
ments of the eyeball are impaired. Pus soon forms, when we 
have an abscess in orbit, which may perforate through lids or 
conjunctiva. The inflammation may extend to the eyeball, pro- 
ducing a panophthalmitis, or to the brain, or may cause caries of 
orbit, etc. General febrile disturbances usually accompany the 
above local inflammation. Trauma is the most frequent cause. 
It may result from extension of inflammation in neighboring- 
parts or from constitutional diseases. 

THERAPEUTIC HINTS.— Aeon., Apis, Hepar, Laches., Mercur. 
and Silic. may be indicated, but Rhus tox. is most frequently 
indicated." (Geo. S. Norton). 

Basedow's or Graves' Disease ; Exophthalmic Goitre, 

Is characterized by palpitation with accelerated pulse, swelling 
of the thyroid gland, and exophthalmus or protrusion of the eye- 
balls. In its nature it has been considered by some as a morbid 
crasis, by others as a heart disease and by still others as a neuro- 
sis of either the cervical sympathetic or the cervical medulla spi- 
nalis and medulla oblongata. I feel, therefore, at liberty to treat 
of it here as anywhere else. 

Autopsies have shown a considerable development of fat be- 
hind the eyeballs, which causes their protrusion ; also at times 
fatty degeneration of the eye-muscles, probably caused by disease 
and stretching; and atheromatous changes of the ophthalmic 
artery. Changes in the sympathetic and its ganglia have not at 
all been of a uniform nature, and in some cases have been want- 
ing altogether. 

Symptoms. — Usually this disease develops itself very slowly. 



Basedow's or graves' disease. 185 

though some few cases of sudden origin have also been observed. 
Its first symptom in a majority of cases is palpitation conjoined 
with acceleration of the pulse, without any abnormal symptoms 
of the heart on physical examination ; occasionally there are 
epigastric pulsation, increased force of the pulse in the carotids 
and their larger branches, especially the thyroids, and a whir- 
ring and blowing that may be heard by auscultation before the 
struma is developed, pulsation of the retina and in rare cases 
pulsation of the liver. Some weeks or months later, slowly or 
rapidly, struma is developed, a soft, elastic swelling of the entire 
thyroid gland, which, however, does not attain to a very great 
size and is moreover subject to frequent changes. The surface of 
the tumor is often marked by veins, greatly dilated and crowded 
with blood, and auscultation reveals loud blowing sounds, often 
increased during systole. Struma seldom appears before palpita- 
tion and still more rarely is it wholly absent. Exophtkalmus, the 
third prominent symptom, makes its appearance soon after the 
struma — in a few cases before it — and still more rarely as the 
initial symptom, preceding the struma and the palpitations. It 
always attacks both eyes, but sometimes appears on the one eye 
earlier, or remains at least more prominent than on the other. 
It seldom is wholly wanting, while in other cases it forms the 
only cardinal symptom, when it is associated with other kinds 
of general disturbances. In degree it varies greatly, from a 
slight prominence of the eyeballs to an excessive protrusion of 
the same, that no part of the globe is covered by the eyelids and 
even may amount to a luxation of the globe. The eyes protrude ; 
the eyeballs have an unusual lustre, appear stiff and gradu- 
ally lose their mobility in part or wholly. But this pro- 
trusion is not at all times the same, it increases and decreases 
proportionately to the force of the pulsations of the heart, and 
sometimes may be diminished by light pressure upon the eyeball. 
Von Graefe has observed, that " the upper lid loses its power to move 
in harmony with the eyeball in the act of looking up or down," and he 
considers it a pathognomonic sign of exophthalmus, which how- 
ever others do not admit, as its occurrence, although frequent, is 
not constant. As a secondary group of symptoms in some cases 
may be mentioned: dryness of the conjunctival sac, distention of 
the conjunctival veins, and conjunctivitis ; the lachrymal secre- 
tion is often increased. In bad cases : insensibility, diffuse desic- 
cation or even perforation of the cornea. Ophthalmoscopic ex- 



186 ORBIT. 

animation usually shows dilatation and increased tortuosity of 
the retinal veins, and in some cases spontaneous pulsation of the 
retina. The temperature of the body has been found increased 
to 101.8° F. in some cases, while in others it remained entirely 
normal. Also nervous disturbances have been observed, but 
they are so varied and so little characteristic, that they may be 
omitted without injury to the diagnosis of this malady. Its du- 
ration is protracted ; months and years may pass with alternate 
improvement and relapse; some cases get well; others hasten to 
a fatal issue by the consecutive changes of the heart, the perma- 
nent increased labor of which leads to dilatation of both ventricles 
and compensating hypertrophy. In other cases marasmus and 
other intercurring diseases or complications may end the scene. 
Women are more subject to it than men ; in childhood it is 
rare, it occurs mostly during the time of puberty and climacteric 
years, seldom later. As predisposing Causes have been men- 
tioned : chlorosis, anaemia, and neurotic tendencies ; as exciting 
causes have been found : injuries, traumatic or otherwise, and 
mental excitement, violent fright. 

THERAPEUTIC HINTS.— As this affection is not poor in symp- 
toms and mostly of long standing, by a careful examination we 
will be able to detect leading symptoms for one or another 
remedy, even not mentioned below. 

Amyl nitr., frequent flushes of face and head; oppression of 
chest; tumultuous palpitation. (Olfaction.) 

Badiaga. (Norton.) 

Bellad., has cured cases in allopathic hands, although the doses 
applied were certainly too massive, as they produced headache, 
nosebleed and angina. 

Calc. carb., in combination with a diet of nitrogenous substances 
relieved greatly in a case of pronounced lymphatic constitution. 

Ferrum, in cases with disturbances in the sexual sphere, scanty 
or suppressed menses and great nervousness. 

Lycopus, has relieved the protrusion of the eyes and the cya- 
nosis, but had no effect upon the glandular enlargement, which 
yielded to Iodine. 

Natr. mur., depressed vegetative vitality; despairing, hopeless 
feeling about the future; dryness of the mouth; sore tongue: 
map tongue; chronic constipation with hard stool; chlorotic 
symptoms, with dirty, flaccid, torpid skin; fluttering of the heart ; 
intermitting and irregular pulse. 



Basedow's or graves' disease. 187 

Secale has been successfully used by the old school. 

Spongia, easily frightened, especially at night, as if suffocating. 

It appears from this, that the most efficient remedies used thus 
far were such which are capable of acting especially upon the 
heart and the thyroid gland ; under certain circumstances, there- 
fore, Baryta carb., Bromium, Cact. grand., Phosphor., Silic. and Sulphur 
may likewise be indicated. 



EARS. 



Analogy between the Ear and the Eye. 

At first sight, these organs appear so entirely unlike each other, 
that it would seem scarcely possible to discover any analogy be- 
tween them; yet on closer inspection, the similarity between the 
two is quite striking. 

As I consider this similarity in the structure of the eye and 
ear of great importance in clearing up the rather occult affections 
of the ear (the treatment of which is often very difficult), I shall 
point out, with some detail, the following remarkable features of 
similarity between the organ of sight and the organ of hearing. 

The pinna corresponds to the upper and the tragus to the lower 
eyelid. In animals the auricle is even movable, to collect or re- 
ject sounds, as the eyelids are to take in or to keep out the light. 

The eyelashes are represented by the bristly hairs at the mouth of 
the meatus externus; to keep out dust and insects. 

The meatus externus is lined by a semi-mucous membrane, 
secreting earwax, corresponding to the conjunctiva of the eye. 
which secrets eye-butter ; both are subject to similar inflamma- 
tions and mucous or purulent discharges. 

The membrana tympani, corresponds not only in function, but 
also most strikingly in structure, with the cornea. It collects 
sounds, while the cornea collects light; and it is, at least, of a 
half- transparent texture. The diseases to which it is liable cor- 
respond with those of the cornea: inflammation, thickening, 
ulceration and perforation. 

Immediately back of this membrane, in the middle ear or tym- 
panum, we find the ossicula auris, by which sound is broken and 
communicated to the auditory nerve, in the labyrinth, just as 
light, by means of the crystalline lens, is refracted upon the optic 



GENERAL OBSERVATIONS ON THE EAR. 189 

nerve. The middle ear or tympanum, with its ossicula, corre- 
sponds, therefore, precisely to the anterior and posterior chamber of 
the eye with the lens. 

Still further back we come into the labyrinth of the ear, which 
is filled, in its membranous portion, with a limpid fluid, first well 
described by Scarpa, and which corresponds to the vitreous 
humor of the eye; while the numerous filaments of the two 
branches of the auditory nerve, the vestibular and cochlear 
nerves, spread out into a nervous membrane, closely resembling 
that of the retina, so that the labyrinth of the ear corresponds 
to the posterior part of the eye with its vitreous humor and its 
retina. The nerve-membrane of the ear terminates in fine 
fibrils or cilise (Corti's mechanism), and the retina in a layer of 
rods and cones. 

There is one appendix to the ear — the Eustachian tube — which 
starts at the tympanum, and opens into the lateral wall of the 
throat, and there is also one appendix to the eye — the lachrymal 
duct — which starts at the inner canthus of the eye and opens into 
the nose; while lastly both organs are situated in close proximity 
to porous bones : the ear on the mastoid portion of the temporal 
bone, and the eyes below the frontal sinuses of the frontal bone. 

This striking similarity in the structures of the ear and eye at 
once brings the diseases of the ear (by comparing them with 
those of the eye) nearer to our comprehension, and may even 
influence the choice of a remedy in a given case. 

General Observations on the Ear. 

The auricles grow pale from fright, chills, spasms, loss of vital 
fluids, exhaustion and frost. A marked paleness of the left auricle 
denotes inflammation of the spleen. 

Redness of the auricles is found in congestive and inflammatory 
conditions of the head and ears. 

Flushes are caused by mental emotions; or occur before bleed- 
ing of the nose, delirium,, apoplexy. 

An habitual or frequently-occurring redness of the auricles denotes 
disturbed actions in the abdominal organs; or else menstrual 
and hemorrhoidal affections. Hyperemia of the auricle, and 
sometimes of the middle ear, is often associated with the climac- 
teric period. 

A striking redness of the auricles in new-born children is a sign 
of premature birth. 



190 AURICLE. 

Small, inflammatory, purplish, suppurating spots on the auricles 
are a sign of chronic syphilis. 

A slight inflammatory, painful redness of the upper part of the 
auricle is often the forerunner of an attack of gout. 

Swollen auricles, if inflammatory, are caused by erysipelas, in- 
juries, eruptions; if habitual, not inflammatory, it is a sign of 
scrofulous conditions ; if ozdematous, a consequence of abscesses or 
Bright's disease. The auricles are: 

Hot, in inflammatory and congestive conditions of the head 
and ears, also in consequence of great exertion of the voice, and 
in diseases of the larynx. 

Cold, in chills, spasms, and from exhaustion. Auricles habitually 
cold are found in weak and chlorotic individuals. In hysteric 
persons, cold auricles are the forerunners of a hysterical spasm; 
while in delirium and mania they denote a cessation of the 
paroxysm. 

Discharges from the ears may originate either in the meatus 
auditorius externus, in the middle ears, (the tympanum), or in 
the cavity of the skull. They are of various characters. 

If, after a, fall or external injury of the head, there be a discharge 
of blood, it denotes a fracture of the skull. The ears bleed also 
in scorbutic affections ; from too great a pressure, or from insuffi- 
cient pressure of the atmospheric air, (cannon-shot; on high 
mountains;) from too great exertions in screaming, coughing, 
vomiting, straining, blowing musical instruments. 

Pus or ichorous matter is the product of a previous inflamma- 
tion, either in the meatus auditorius or in the middle ear. In 
rare cases the pus comes from an abscess in the brain, which has 
broken through the petrous portion of the temporal bone. 

Thin earwax is, in most cases, the consequence of a chronic in- 
flammatory state of the meatus auditorius externus. 



THE AURICLE. 
Eczema. 

Various kinds of eruptions may befall the auricle, either spread- 
ing to it from adjacent parts or originating there. From among 
them eczema is the most common, differing in no way from its 
kind on other parts of the body. We meet it in its acute as well 
as in its chronic form, and very often associated with similar 



EXAMINATION OF AUDITOKY CANAL. 191 

eruptions on the scalp, or face or other parts of the body. It may 
affect the entire lobe, or select only certain portions of it ; the 
sharp crevice behind the ear, where the auricle joins the mastoid 
process, is frequently its favorite seat. 

THERAPEUTIC HINTS.— Baryt. carb., Calc. carb., Graphit, Hepar, 
Lycop., Merc, sol., Nitr. ac, Oleand., Petrol., Rhus tox., Sulphur, are the 
main remedies. For particulars compare Eczema of the Scalp. 

By their position the auricles are naturally exposed to various 
external injuries, from blows, cuts, heat or cold, and they also are 
not unfrequently the seat of depositions of urate of soda in ar- 
thritic patients. Their lower lobe is often disfigured by hyper- 
trophy or little, round, hard tumors in consequence of previous 
piercing. 

THE AUDITORY CANAL AND THE DRUMHEAD, OR 
MEMBRANA TYMPANI. 

Examination of these Parts. 

The canal is not straight but curved on its anterior and lower 
wall and often obstructed by hair growing from its cartilaginous 
walls. The drumhead is placed obliquely across the canal at its 
furthest extremity which it shuts off from the middle ear. In 
consequence of the crooked structure a simple look into the ear 
does not give us a full view of its walls nor of the drumhead. 
We have to straighten its curved course and push aside obstruct- 
ing hair or other impediments, as far as possible. This can best 
be done by an ear-speculum, which consists of a simple funnel- 
shaped tube, made of polished metal. There are usually three 
of different diameters fitted together, for the purpose of giving 
choice to select that which best corresponds to the dimensions of 
the canal under examination. Its application is the following. 
Draw the auricle upwards and backwards, and insert the tube by 
gentle turning and twisting into the meatus as far as it can be 
done without using force or causing pain. Keep it then in its 
position and illuminate through it the parts to be examined. 
The best light is clear daylight or lamplight; the direct rays 
of the sun may be too dazzling. In order to prevent the inter- 
vention of the head of the observer with the rays of light an ordi- 
nary laryngoscopic mirror or reflector fixed upon the forehead of 
he observer, or one of shorter focus made for the purpose of aural 



192 AUDITORY CANAL AND DRUMHEAD. 

requirements, or, for preliminary examination, even a common 
hand-looking-glass can so be held as to reflect the rays of light 
into the tube, that by a little management and turning of the 
ear-speculum we are enabled to inspect already the drumhead 
and the walls of the external canal in all their parts. 

The membrana tympani, or drumhead, is a thin, semi-transpa- 
rent, parchment-like membrane, spread obliquely across the ex- 
ternal auditory canal at its farthest extremity. In its normal 
state its surface, as seen through the ear-speculum, appears con- 
cave. Its shape is that of an irregular oval disc, the long axis of 
which is directed from above downwards; it is attached to a well- 
marked bony groove upon an elevated ridge upon the bony canal 
— the Ammlus tympanicus, being fixed to it by a cartilagenous ring 
— the Ammlus cartilagiaus, just as is the crystal of a watch to its 
bezel. 

It is composed of "three distinct structures, the external layer 
being a prolongation of the skin of the meatus externus, the 
internal being derived from the mucous membrane of the middle 
ear, while between these two comes the fibrous layer, and which 
is itself composed of two distinct layers, the one external, the 
fibres of which radiate; the other internal, the fibres of which 
take a circular course." 

"When we look at the healthy membrane, we may observe at 
its uppermost edge a whitish prominent part, the short process 
of the malleolus, and extending from this downwards and back- 
wards nearly to the centre of the membrane; we see a whitish or 
pale yellow stripe, and which is the malleus handle, widening 
out at its lower end into the form of a spatula. In front of and 
below the manubrium we see a triangular reflection, the cone of 
light, its apex being at the umbo, or deepest point of the convex- 
ity of the membrane, its base forwards and downwards towards 
and slightly short of the periphery; and then we may, on look- 
ing closely, sometimes see shining through the membrane the 
promontory of the middle ear, and the long process of the incus." 
(Cooper). 

The color of the membrane is a peculiar gray of different 
shades, conditioned by its transparent nature, by the bodies 
which lie behind it and the light which strikes upon it. If the 
mucous membrane which lines its internal surface, or that of the 
entire middle ear is congested, we find the natural gray mixed 
with a faint or deep red; or with a yellowish tint when the 



EARWAX. 193 

middle ear is filled with yellowish secretion. Indeed pathologi- 
cal changes have a marked influence upon the color of the mem- 
brane. So also is the natural soft gloss of the membrane greatly 
altered or even extinguished by pathological processes. The 
brightest reflection from the healthy membrane is the "cone of 
light," a triangular reflex of light in the anterior and inferior 
quarter of the membrane, which has its apex in the umbo and 
its base near along the periphery of the membrane ; it is analo- 
gous to the reflex of light of the cornea. Its locality and bright- 
ness too changes from various pathological conditions. 

The External auditory canal is lined by a continuation of the ex- 
ternal skin, which grows thinner as it approaches the drumhead, 
but is not changed to a mucous membrane. It is studded by nu- 
merous sebaceous and ceruminous glands from which the earwax 
is derived. 

Earwax Diminished or Increased. 

The lining of the auditory canal being a continuation of the 
external skin, great dryness of the same is usually found in per- 
sons whose skin in general is of a dry nature. It seldom has 
anything to do with nervous hardness of hearing. It may, how- 
ever, be in connection with turbid processes within the middle 
ear, especially the drying up and hardening process of its mu- 
cous membrane. 

An increase of earwax may be caused by frequent picking and 
boring with hard instruments in the ear, whereby a congested 
state of its lining membrane is induced; we find it in persons 
whose scalp produces much sebaceous secretion and who are in- 
clined to sweat easily about the head ; it is sometimes connected 
with a chronic eczema of the canal. Its accumulation usually 
goes on slowly and the forming of hard plugs of cerumen takes 
frequently a long time, the patient being not at all aware of their 
formation, until a gradually increasing deafness reminds him of 
something wrong in his ears. In other cases indurated earwax 
causes quite annoying symptoms. Besides hardness of hearing, 
amounting sometimes to deafness, there is great itchiness of the 
meatus, or a feeling of fulness and heaviness in the head, or 
there are spells of pain deep in the ear, and in some cases even 
serious attacks of vertigo. These attacks of vertigo in conse- 
quence of hardened earwax are caused by its pressure upon the 
13 



194 AUDITORY CANAL AND DRUMHEAD. 

drumhead, which is propagated by the chain of the ossicula to 
the fluid of the labyrinth. It is a symptom also of other affec- 
tions of the labyrinth. 

The hardened plugs of cerumen consist either of an amorphous, 
dark brown-red mass, principally made up from the secretion of 
the sebaceous and ceruminous glands, or they are strongly mixed 
with scales of the epidermis and in old persons with hair; some 
old plugs, which shine like mother-of-pearl, are mixed with choles- 
terin ; and in still others we find an admixture of cotton, seeds, 
dirt and other substances from the surrounding atmosphere. 
There are, however, cases where the hardened masses which ob- 
struct the auditory canal have originated in the middle ear, and 
consist of dried pus mixed with blood, in consequence of catarrh 
of the middle ear and perforation of the drumhead; in still 
other cases the plugging up material consists of accumulated 
masses of fungi or the formation of polypi. All this must be 
borne in mind. Deafness from hardened plugs of cerumen will 
certainly be cured by the removal of this obstruction, while in 
complications with affections of the middle ear this is, by far, 
not so certain. Here the tuning fork will give us the best in- 
struction. When deafness is caused by mere obstruction of the 
external meatus, the tuning fork vibrating on the vertex is heard 
better in the obstructed ear, contrary to the patient's expectation. 
When, however, we find that it sounds louder in the ear which 
is not affected or is heard, at least, no better in the obstructed 
ear, we may assume that there is some complication in the inner 
ear, and need not expect a full return of hearing after the re- 
moval of the obstruction. 

THERAPEUTIC HINTS.— Plugs of hardened earwax must be re- 
moved and to do this there is nothing so expedient and harmless 
as injections of luke-warm water, by a suitable ear-syringe. It is 
not necessary to do it forcibly and if, as in some cases, the plug 
is very hard, and adheres very tightly to the walls of the canal, 
it is better to take for its accomplishment two or three sittings 
and in the meantime have the hardened substances softened by 
occasional application of warm water, than to try to force it in 
one sitting. "Carbonate of soda added to the warm water hastens 
the removal of cerumen." (Houghton.) Often the hearing may 
be worse and a feeling of fulness come on after the first sitting, 
in consequence of the swelling of the hardened mass, and the en- 



FURUNCLES OF THE EXTERNAL CANAL. 195 

tire closing up of the canal. The patient ought to be advised of 
this possible seeming aggravation. After the earwax is removed 
it will always be advisable to put some cotton or wool into the 
ear in order to protect the drumhead from shrill sounds and 
cold. But why does the earwax accumulate and harden in some 
persons, and not in others ? There surely must be some consti- 
tutional reason for it, which we must try to mend, otherwise the 
same process will go on again. The following remedies must be 
considered : 

Carb. veg„ " has served me well in malsecretion of cerumen with 
exfoliation of dermoid layer of meatus." (Houghton.) Discharge 
of flesh-colored, offensive moisture from right ear ; deficient or 
badly-smelling cerumen. 

Conium, accumulation of earwax, looking like decayed paper 
(scales of epidermis) mixed with pus or mucus, or blood-red; 
hardness of hearing ceasing when the wax is removed and re- 
turning with the wax. 

Graphit, in young persons with habitual herpetic eruptions in 
the meatus ; or meatus dry and scabby. 

Laches., want of wax ; ears very dry. 

Mur. ac, accumulation of wax which is dry and hard, and of a 
brown-red color, with hardness of hearing. 

Petrol., large quantities of thick or thin wax; sensation of rush- 
ing of water in the ear ; old aged persons. 

Furuncles of the External Canal. 

They correspond entirely to boils on any other part of the 
body. Starting at first as an inflammation of a hair-follicle or of 
a glandular follicle, by spreading, the surrounding subcutaneous 
connective tissue is drawn in the same process and a limited ab- 
scess is formed. In the auditory canal their size is naturally 
still more limited ; they may, however, for a time completely 
close the canal, until they break and discharge the core. They 
are quite painful and sometimes we find several together or fol- 
lowing each other. They correspond to styes on the eyelids. As 
a diagnostic sign from abscesses, Cooper states, that when they 
discharge, the pillow case in the morning will be studded over 
with stains so closely resembling small sized buttons, as to de- 
ceive the most clear-sighted at a distance. 

THERAPEUTIC HINTS.— Hepar, Merc, sol, Pulsat, Sulphur. 



19G AUDITORY CANAL AND DRUMHEAD. 

"Picric ac. is as near a specific for small furuncles in any part 
of the body as any remedy can be. In the meatus externus it 
aborts the furuncle if seen early and mitigates, if advanced, as 
well as corrects the habit." (Houghton.) " Furuncles in exter- 
nal auditory canal dependent upon mental overwork." (Geo. S. 
Norton). 

Otitis Externa, or Diffuse Inflammation of the Auditory- 
Canal. 

In its Acute form it commences frequently with itching, heat 
and a sensation of dryness in the ear, which gradually changes 
to a dull pain or a boring and tearing deep in the ear, and being 
generally worse in the night, deprives of sleep and causes fever- 
ish restlessness. In severe cases the pain may extend all around 
the ear and to the corresponding side of the head. A jar from 
sneezing or coughing, or the motion of chewing or gaping make 
it worse. The hearing grows duller in the degree in which the 
outer lining of the drumhead becomes involved. On inspection 
we find it congested and swollen and also the lining of the 
canal; gradually exudation ensues, which at first is watery but 
finally becomes yellowish and purulent. With the establishment 
of otorrhoea the pain decreases, the epidermis loosens and the 
canal fills up with the products of desquamation. This state of 
things may gradually wear off and heal, or it may become 
chronic; the otorrhoea may continue for years. Usually Chronic 
otitis externa takes its origin in an acute attack as described 
above; but there are cases where such acute and painful out- 
breaks are not remembered; very often the commencement dates 
back to infant life. Sometimes the otorrhoea ceases for a time, 
especially during summer, but comes back again with damp and 
cold weather or from any other exciting cause. This form is 
often characterized by the presence of fungi. Chronic otitis may 
lead to ulceration, deep opacity and extensive thickening of the 
drumhead, to narrowing of the external canal by hyperostosis, to 
polypous growths within the canal, or to an extension of the in- 
flammatory process to the middle ear or the neighboring dip- 
loe'tic bony structures, or even to the dura mater and brain. 
Deafness of various degrees is a usual concomitant, 

The Causes of external otitis are various. Acute and chronic 
exanthemata; eczematous eruptions; pemphigus: irritating sub- 



EXAMINATION OF THE MIDDLE EAR. 197 

stances; fungi of the aspergillus kind; exposure to cold draughts. 
Most liable to its attacks are children. 

The Prognosis of an acute attack may be called favorable ; 
the chronic form is mostly difficult to manage. 

THERAPEUTIC HINTS.— As soon as dtorrhcea has commenced, 
great care should be taken to keep the ear clean. Occasional in- 
jections of luke-warm water, administered carefully, are of great 
benefit. " Aurists are now beginning to advise dry applications, 
avoiding warm water, except in acute troubles." (Houghton.) 
As regards the remedies, compare Otitis Media. 

THE MIDDLE EAR. 

The cavitas tympani is bounded exteriorly by the drumhead ; 
interiorly by the wall of the labj^riuth; its roof divides it from 
the brain; under its floor, which is very irregular in shape and 
greatly varying in thickness and compactness in different per- 
sons, even sometimes in the two ears of one and the same per- 
son, lies the vena jugularis interna; on its posterior wall we find 
the inlet to the antrum mastoideum, and on its anterior wall, 
nearer to the roof than the floor, just opposite to the antrum mas- 
toideum, is the mouth of the Eustachian tube. 

The entire cavity is lined by a mucous membrane, which is 
smooth, whitish, ver}' thin and tender. It does the service of the 
periosteum, as it contains the vessels which nourish the bony 
structure underneath. 

The antrum mastoideum and the numerous air-containing 
cells of the mastoid process are a kind of air-reservoir and reso- 
nator, a very important appendix to the middle ear, as by it the 
sonorous vibrations are more or less controlled. The Eustachian 
tube on the other hand is the draining canal for the secretions 
of the middle ear, and also its ventilation tube. For its outlet, 
which in grown persons resemble the mouth-piece of a trumpet, 
opens into the naso-pharyngeal cavity, where it is constantly ex- 
posed to the stream of atmospheric air during respiration, by 
which communication the air in the middle ear is kept in the 
nearest possible equal tension with that of the atmosphere. 

Examination of the Middle Ear. 

1. By means of the Ear Speculum.— We can ascertain by its appli- 
cation the color and condition of the drumhead. When it is of 



198 THE MIDDLE EAR. 

a reddish tinge, there is inflammation of its inner lining, in con- 
sequence of catarrh of the middle ear; when it bulges there is an 
accumulation of mucus or pus behind it; when it is perforated 
we may be able to view the condition of the ossicula behind it. 

2. By means of Valsalva's Method. — This consists of a forced ex- 
piration by the patient himself, by keeping mouth and nose 
tightly shut. The effort of blowing without allowing the air to 
pass out either of the mouth or the nose forces it into the Eus- 
tachian tubes, through which it enters into the ears where it 
causes a sense of fulness and a crackling in the drumheads, which 
from the internal pressure are made to bulge, provided the Eu- 
stachian tubes be pervious. If this sense is not produced, or 
only in one ear, we know that then and there the Eustachian 
tube or tubes are closed. This method requires intelligent pa- 
tients. " In many cases the testimony of the patient is negative 
as regards the passage of air, when test with the watch shows 
that it did pass into the tympanum." (Houghton.) 

3. By means of Politzer's Method. — This consists of blowing, by 
means of an india-rubber bag with a tube, a current of air into 
one or both nostrils of the patient in the moment when he is 
made to swallow a sip of water. The nostrils, of course, must 
be held shut so that the current of air cannot return through 
them, while the act of swallowing closes the upper portion of 
the pharynx, preventing the air from escaping through the 
mouth. Thus it has to pass through the Eustachian tubes into 
the ears of the patient, of which he will be cognizant by a cer- 
tain fulness and pressure in the ear, or in case of perforation of 
the drumhead, by a whistling sound and a simultaneous ejection 
of collected mucus into the external meatus. This method, too, 
requires intelligent patients, but it excels over Valsalva's method 
in this, that it acts more energetically. 

"Politzer's method of inflation can be made available without 
the use of water in most cases by directing the patient to close 
the mouth and blow steadily as in the act of whistling, or blow- 
ing out a candle. In children the tympanum can usually be in- 
flated without either expedient ; a forcible emptying of the air- 
bag will dilate the Eustachian tube and fill the cavity." — 
(Houghton.) 

4. By means of Catheterism. — It consists of blowing air into the 
middle ear by means of an Eustachian catheter. Here are Kra- 
mer's directions for the introduction of this instrument. "As a 



EXAMINATION OF THE MIDDLE EAR. 109 

rule, the catheterism of the Eustachian tuhe should he accom- 
plished with one of the catheters of size 1 to 4, introduced through 
the corresponding nasal meatus of the ear, that is to be examined. 
For this purpose the patient is to be placed upon a chair with a 
common back, or with one somewhat higher than usual, in order 
that the head may be supported." "After the patient has blown 
his nose (partly for the purpose of clearing away a too abundant 
secretion, partly, in case the nose is too dry, to moisten it, and 
thus enable the instrument to slide along it with greater facility), 
we dip the catheter into pure olive oil, and blow through it to 
assure ourselves of its permeability. The head of the patient is 
then fixed with the left hand ; the catheter is held with the 
thumb and finger of the right hand close to the funnel-shaped 
extremity, in such a manner that the ring attached is downward; 
the beak is placed in the nasal meatus, resting upon its floor, 
close to the septum, with the convexity upwards. From this 
point it is pushed backwards with a very light hand, sweeping 
as much as possible along the floor of the nostril, with continual 
elevation of the handle, till the instrument becomes horizontal 
and its extremity rests against the posterior wall of the pharynx. 
The thicker the catheter, the more easily are these movements 
executed." 

" Irregularities in the form of the inferior turbinate bone and 
strong lateral displacement of the septum may render the first 
introduction of the catheter very difficult, and test severely the 
delicacy of the sense of touch in the hand of the operator. As 
the point of the beak arrives at the posterior wall of the pharynx, 
the funnel-shaped end of the catheter is to be raised a little above 
the horizontal line, and at the same time to be lightly with- 
drawn. The beak then sinks and rests upon the posterior wall 
of the soft palate, which at that instant contracts, performs a 
swallowing movement, raises itself, and when assisted by a 
quarter turn upon its axis from within outwards, lifts the beak 
of the instrument into the tube." 

" If this rapid movement is not successful in the hands of an inex- 
perienced person, the beak of the catheter must be conducted back 
to the upper part of the pharynx, in order that it may be slowly 
drawn forwards and turned at the same time laterally a quarter 
turn upon its axis towards the outside, by which means the ring 
of the funnel-shaped end is directed horizontally. It now slides 
over and into the swelling of the tube itself, where the beak of 



200 THE MIDDLE EAR. 

the catheter is directed, with its cavity against the anterior 
swelling of the tuhe, and here it hooks into it and can be clearly 
felt to be grasped by it upon quickly withdrawing it. The 
catheter lies here quite conveniently, being in no way a source 
of annoyance to the patient, even in speaking, in swallowing, or 
in any of the movements of the head. For the sake of security 
we now elevate the beak of the catheter above the horizontal 
line, directing it upward and outward, the position of the beak 
being determined and rendered evident by the direction of the 
ring upon the funnel-shaped end." 

After a successful introduction of the instrument, the operator 
blows either with his mouth or by means of an india-rubber 
ball into the tube, through which the current of air is trans- 
mitted into the middle ear. On listening during this operation 
by either putting the ear to the ear of the patient, or by means 
of an otoscop, we hear the air rush in and beat on the drumhead, 
which produces a harsh sound when the drumhead is very dry, 
and a soft or moist sound when the drumhead is moist, A thin, 
interrupted, or whistling sound indicates an obstruction of the 
Eustachian tube; a rattling noise, as from some distance, in- 
dicates that the Eustachian tube is lined with mucus: a rattling 
sound, which appears to originate nearer, indicates a collection 
of mucus or pus in the middle ear; a fine, sharp whistling, with 
ejection of pus into the external meatus, indicates perforation of 
the drumhead; a distant, faint and indistinct noise proves that 
the air does not reach the middle ear at all, either because the 
catheter is not correctly inserted into the outlet of the Eustachian 
tube, or because there exists an obstruction in the tube which 
the air-douche cannot overcome. 

5. By means of the Watch. — If we want to ascertain the distance 
at which a patient is able to hear, we must use an instrument 
which gives a sound always of the same nature and strength, 
and which can easily be held at different distances from the ear, 
to be examined. Such an instrument is the watch. We com- 
mence by holding it at a distance and bring it gradually nearer 
to the ear until its tick is perceived; the reversed order might 
give rise to mistakes. As soon as the patient can indicate the 
tempo of the tick, we are sure that he hears it, and we know the 
distance in which he hears by exact measurement. 

6. By means of the Tnning-fork. — It is a known fact, that the 
sound of a watch or a vibrating tuning-fork, when placed on the 



EXAMINATION OF THE MIDDLE EAR. 201 

bony structure of the head or on the teeth, is heard at once louder 
as soon as we shut the ears, by lightly inserting one finger into 
each ear. If^we close only one ear, Ave hear the sound louder on 
this side than on the other. This physiological fact has been 
made use of in the diagnosis of ear diseases, where, in some cases, 
it gives valuable hints. 

The same effect, namely, which is produced by closing the ear 
with a finger, must be brought about by any morbid obstruction 
within the ear which interferes with the normal conduction of 
sound. And what prevents the sound from entering into the ear, 
must necessarily prevent the sound-waves also from passing out 
of the ear, when produced by and conducted to the inner ear by 
vibrations of the skull-bones ; consequently they must be reflected 
back to the labyrinth and thus be perceived doubly as loud. 

The causes, which may act similar to an artificial closure of 
the external meatus, are various. It may be a collection of ceru- 
men, a foreign body, or a furuncle in the external canal, or ob- 
struction of the Eustachian tube, or myringitis, or thickening of 
the drumhead; it may be a collection of secretion about the 
ossicula, or a want of flexibility, or even a partial destruction of 
the same, or a softening or thickening of the membranes of the 
fenestra? to the labyrinth. In any of these conditions the patient 
will surely hear the tuning-fork, which, by the way, gives the 
best and truest results, when placed on the median line of the top 
of the head, loudest in that ear which is thus affected. 

If the patient, on the contrary, should hear the tuning-fork 
better in the sound or comparatively well ear, and less distinctly 
in the affected one, we may assume with tolerable probability 
that the affection of the bad ear consists of a loss of sensibility of 
the Acusticus in the labyrinth. 

However, even here we must not be too rash in our conclu- 
sions, and remember that there is a great difference in the ca- 
pacities which patients, and even persons in health, manifest with 
regard to their power of distinguishing the vibrations of a tuning- 
fork placed upon the head. Aged persons as a rule have much 
less capacity of perceiving the vibrations of a tuning-fork, than 
persons below fifty years of age. It will be well in all cases to 
place the tuning-fork as a controlling experiment, also upon the 
front teeth of the lower-jaw. A peculiar observation of A r on 
Trcelsch is, that the tuning-fork, when placed on the head, very 
quickly ceased to vibrate in cases of a very unfavorable nature. 



202 THE MIDDLE EAR. 

Otitis Media. 

Under this name I intend to treat what Von Troelsch has 
separately and elaborately described as simple catarrh and puru- 
lent catarrh of the middle ear. Both forms represent an inflam- 
matory state of the mucous lining of the cavity of the middle 
ear, the mastoid cells and the Eustachian tube, either in part or 
in toto. The first is the lighter form, producing a mucous secre- 
tion which, however, at times may be mixed with pus and blood ; 
the second is the more serious form, characterized by its puru- 
lent secretion, and mostly ending in perforation of the drum- 
head. It may be the result of simple catarrh, and I do not find 
any characteristic signs by which the two could positively be 
distinguished from each other at the commencement. 

The catarrh of the middle ear is either acute or chronic. Its 
Acute form is mostly very painful; only exceptionally it runs its 
course without pain, especially in tuberculous individuals. The 
pain is felt deep in the ear, is sometimes excruciating and ex- 
tends over the whole of the affected side of the head ; it is usu- 
ally not increased b} r pulling at the auricle or b} T pressure upon 
the parts before the ear, but gets decidedly worse from swallow- 
ing, or any quick movement of the head, or any concussion from 
a hard step, and at nights. If the mastoid process becomes in- 
volved, there is pain in that region and sensitiveness to pressure, 
and according to Cooper, even at an early stage " we can find a 
little gland situated midway over the mastoid process and on a 
line with the anterior opening of the auditory canal, immedi- 
ately behind the auricle, become tender and swollen, while its 
immediate surroundings are insensitive to pressure." This in- 
flammatory process is further attended by high fever and sleepless- 
ness, when it may indeed simulate an acute meningitis ; by deaf- 
ness of various degrees, developing either suddenly or gradually, 
and caused by the exudation which covers the ossicles and de- 
stroys their natural mobility; by "catarrh in the head.'' In fact it 
may have spread from a catarrhal inflammation of the naso- 
pharyngeal mucous membrane, through the Eustachian tube 
into the middle ear. 

There is no age exempt from it, but in childhood it is espe- 
cially prevalent, though it is often not recognized. • 

I might for its diagnosis in little children draw the attention 
to the following Symptoms: high fever; great restlessness: cry- 



OTITIS MEDIA. 203 

ing and screaming without apparent cause, sometimes in spells 
or incessantly for days. The child gets worse from any motion, 
especially of the head, from being rocked, from swallowing and 
especially when sucking. In fact it cannot be made to suck, it- 
lets the nipple go at each attempt of drawing. Often the little 
ones bring their hands automatically to the affected side of the 
head. In some cases the pressure of the exudation within the 
ear causes vomiting, somnolence alternating with great restless- 
ness, delirium, partial or entire loss of consciousness, convulsions, 
of the limbs or of the facial muscles. If all this is complicated 
with an exanthematic fever, or typhoid fever, pneumonia or 
bronchitis, its diagnosis is indeed difficult. A nasal catarrh or 
an angina might better lead to its discovery. At all events it 
will be well to try the application of warm water to the ears 
in suspicious cases, which gives more or less relief if the ears are 
affected. An examination of the auditory canal in otitis media 
by the ear speculum reveals a slight redness of the canal near 
the drumhead; the drumhead itself appears slightly reddened 
from its congested mucous layer inside, or sometimes shining 
and red, like a polished copper-plate; afterwards or sometimes 
from the first its mild lustre grows dimmer or is lost entirely and 
with it also the cone of light. When the secretion in the middle 
ear increases, the drumhead is marked by single radiating blood- 
vessels and partial bulging, especially of its upper and posterior 
portion. Sometimes the collected pus shines through the drum- 
head and gives it a yellowish appearance. Externally we find 
swellings of the glands around the ear and redness and swelling 
of the naso-pharyngeal mucous membrane. Otitis media termi- 
nates often in perforation of the drumhead. 

Its Causes are exposure to cold, which especially in persons 
prone to catarrhal affections, will often excite this complaint. 
We find it frequently associated with tuberculosis, syphilis, exan- 
thematic fevers, typhoid fever, diphtheritis and croup ; we must 
not lose sight of it during the process of dentition. 

It yields in most cases kindly to homoeopathic treatment. 

THERAPEUTIC HINTS.— Aeon., excruciating pain often in the 
whole affected side of the head with high Over, dry skin, an- 
guish, crossness and restlessness; great sensitiveness to noise; 
auricles hot and red ; meatus externus dry and red ; drumhead 
red, almost copper-colored, with visibly engorged and throbbing 
vessels; after exposure to cold wind. 



204 THE MIDDLE EAR. 

Arg. nitr., ulceration of the drumhead; muco-purulent dis- 
charge from the ear; naso-pharyngeal inflammation. 

Arnica, deep pain and heat extending to the mastoid process; 
feeling of being bruised about the ear; stitches in and about the 
ear; hardness of hearing. Traumatic origin ; from getting chilled 
after being heated ; typhoid fever; pysemic symptoms. 

Arsen., typhoid symptoms with suppression of discharge; lym- 
phatics inflamed; high temperature; collapse; profuse, cold per- 
spiration; pyaemia; pain relieved by warm applications. Burn- 
ing, itching and crawling in external meatus; red, burning pus- 
tules in the canal and upon the auricles. 

Bellad., sticking in and behind the ear; digging, boring and 
tearing; coming and going suddenly, extending to the throat; 
inflammation of the throat; ringing, buzzing and roaring in the 
ear; face flushed; eyes brilliant and staring; congestion to head; 
delirium; deafness or sensitiveness to light and noise; auricle 
red and sensitive to touch ; erysipelas of scalp. Drumhead con- 
gested, enlarged vessels covering its entire surface. After expos- 
ure to cold draughts; cold footbaths; having the hair cut; den- 
tition. 

"The frequent instillation of warm water fas warm as it can be 
borne), either alone or with the addition of a few drops of Bellad., 
will usually relieve the terrible pains while the remedy is ad- 
ministered internally." (Norton.) 

Borax, stitch-pains with involuntary starting; lancinating head- 
ache; itching in the ear; mucous discharge; ear hot: external 
meatus swollen. Children fret and cry and fear downward mo- 
tion. 

Calc. carb., beating pain, with knocking, buzzing and roaring; 
pain from ear to neck and under jaw; worse from evening till 
midnight; better from perspiration: thick discharge; swelling 
of lymphatic glands about ear and neck ; perspiration about the 
head; scrofulous subjects; sensitiveness to cold and damp air; 
period of dentition ; teeth carious and bluish-black at the roots. 

Capsic, itching deep in ear; shooting, pressing pain in and 
about the ear; deep-seated pain under the ear, opposite the angle 
of the inferior maxillary, not extending down the jaw; mas- 
toid process swollen ; middle ear and mastoid cells filled with 
pus; external meatus closed; drumhead perforated. 

"Capsic. is specially valuable in acute necrosis of mastoid pro-, 
cess, or in acute symptoms arising in chronic diseases of the 



OTITIS MEDIA. 205 

mastoid. The full pulse, fever and haggard look of the patient 
are marked features of the picture of the drug. In abscess of 
the mastoid in very young children it has not proved as effec- 
tive." (Houghton.) 

Chamom., catarrhal inflammation; pain in paroxysms; excru- 
ciating; patient beside himself from pain; irritable and cross; 
screaming. Auricle red and hot; face changing color, now red 
and hot and then again pale; or only one cheek red and the 
other pale; hot sweat about the head; green, colicky discharges 
from the bowels; dentition. 

Ferr. phosph., catarrhal affection of the Eustachian tube and 
ear, often combined with catarrh in chest, or bowels, or both. 

Gelsem., catarrhal inflammation at the beginning; cold in head 
and. closure of Eustachian tube; tense, dull, bound, giddy sensa- 
tion in head with chilliness; stupor, drowsiness. 

Kali carb., stitch-like pain and drawing, especially behind the 
right ear; head and right ear hot; face pale, sometimes flushed; 
strong fever with dizziness; chilliness, shuddering; anxiety in 
chest; weary in all the limbs. 

Kali hydr., otitis in rickety children with great tenderness of 
the head. 

Merc, sol., deep-seated, tearing and shooting pain, extending to 
the malar or inferior maxillary bone; worse from evening till 
midnight, by warmth in bed; enlarged, sensitive cervical glands; 
stomatitis or ulcerated sore throat; tongue large, flabby, in- 
dented; fauces inflamed; perspiration from least exertion; oti- 
tis accompanied by facial paralysis. 

Merc, dulc, especially when the Eustachian tube and mucous 
membrane of the pharynx are affected. 

Natr. sulph., sharp, lightning-like stitches in the ear; catarrhal 
affection from damp and rainy weather, cold bathing, playing 
on wet ground; hydrogenoid constitution. 

Nux vom., great pain in ear; hardness of hearing with roaring, 
singing and other noises; auditory canal dry and sensitive; cold 
in head; itching in Eustachian tube; headache; vertigo; period- 
ical nausea and vomiting ; constipation ; creeping chilliness. Bet- 
ter in warm, worse in cold and damp weather. 

Phosphor., painful gathering, first in left and then in right ear, 
and shooting pains through ear worse at night; stopped up feel- 
ing in ear ; itching in ears ; rather deaf in left ear ; deafness to 
human voice; reechoing of his own words. When the ear gets 



206 THE MIDDLE EAR. 

better, styes appear on eyelids, or eruption at the septum of the 
nose; constipation. 

Plantago maj., pain in the ear with pain in the teeth and face. 
The pains are sharp, twinging, running. (Houghton.) 

Pulsai, sharp pain, increasing gradually to great intensity, 
then ceasing suddenly, but soon increasing again; shooting pain; 
hardness of hearing; headache and toothache; carious teeth; 
auricle sensitive ; external meatus red and swollen ; profuse dis- 
charge; phlyctenular inflammation on drumhead, or ulceration 
and perforation; dryness of auditor} 7- canal; catarrh of Eusta- 
chian tubes; swelling of cervical glands; mild disposition; thirst- 
lessness; constant change of position; shifting pains in different 
parts of the body; catamenial irregularities. Worse in evening; 
from heat or close room ; better in open air. 

Rhus tox., pain worse at night and at rest; from cold, damp 
and rainy weather; deafness to human voice. 

Sulphur, drawing, shooting pain; heavy pressure and heat at 
the vertex, extending to both ears, with soreness of the brain ; 
hot flushes of the face, followed by cold sweat; hardness of hear- 
ing, especially for the human voice. In children who suddenly 
cry out with pain, while they appear listless and unobservant, 
and where it seems doubtful whether the irritation be in the 
brain or in the intestinal canal. Styes; swollen nose; eruptions 
on different parts of the body. In complication with meningitis, 
eruptive fevers. 

Tellur., pain day and night, of a dull, throbbing character; 
itching and swelling (left ear), with painful throbbing in the ex- 
ternal meatus; discharge of a watery fluid, smelling like fish- 
pickle, which causes a vesicular eruption upon the external ear 
and neck, wherever it touches the skin ; the ear bluish-red, as if 
infiltrated with water; hearing impaired; rough, angular dispo- 
sition; after scarlet fever. 

Tereb., dental caries and otitis; dental irritation, with symp- 
toms either of cerebral or abdominal irritation ; burning soreness 
and interstitial distention of the gums; suppression of urine and 
convulsions ; wakeful at night, screaming as if frightened ; star- 
ing look; clenching of fingers; twitching of different parts of the 
body; picking of nose; dry, short cough; aching of limbs and 
head; feverishness ; changeable temper; cross and irritable. 
Eczema in front of left ear. (Cooper). 

Verat. vir„ acute otitis. 



THE CHRONIC FORMS OF OTITIS MEDIA. 207 

"Paracentesis of the membrana tympani is advisable, if the pains 
are not readily relieved by remedies, and if there is an accumu- 
lation in the middle ear, causing the drumhead to bulge; for a 
spontaneous rupture may leave a permanent perforation, while a 
simple puncture leaves no bad results, besides at once giving the 
patient relief from the agonizing pain." (Norton). 

The Chronic Forms of Otitis Media. 

Chronic catarrh of the middle ear and its appendices is often 
developed in consequence of acute attacks, sometimes, however, 
without these. It consists either of an interstitial solidification or 
sclerosis of the middle ear tissue (dry catarrh), or of a swelling, 
tumefaction and thickening of the lining membrane, either of 
the middle ear or of the Eustachian tube alone, or of both together, 
or of an ulcerative destruction of the mucous membrane and con- 
sequent perforation of the drumhead (chronic suppurative ca- 
tarrh). 

The Sclerosis of the middle ear tissue yields no discharge, there- 
fore it is called "dry catarrh." Its nature is quite obscure and 
only from post-mortem examinations we know that this patho- 
logical process gradually produces a stiffness and unyieldiness of 
the lining membrane of the middle ear, that greatly interferes 
with the normal vibrating capacities of the drumhead, the ossicula 
and the membranes of the fenestra rotunda et ovalis. Many 
cases of deafness produced in this way have, no doubt, formerly 
been classed under "nervous deafness." 

The Moist catarrh is characterized by hypersecretion and tume- 
faction of the mucous membrane. This originally thin, trans- 
parent and smooth membrane gradually becomes whitish or 
bluish -gray, its substance thickened, and its vascularity increased; 
patches of granulations form upon its surface, and fatty, cheesy 
or calcareous deposits in its periosteal layer. The whole lining 
of the middle ear may thus be changed, and the pathological 
process may extend into the Eustachian tube, making it im- 
pervious for ventilation. 

The Suppurative form manifests itself by its purulent otorrhcea ; 
the mucous membrane appears, in some cases, greatly swollen 
and red, in others only moderately so and pinkish-yellow, and in 
still others, whitish-gray and cicatrized; it is covered with pus. 
At times we find this morbid process attended with caries of the 



208 THE MIDDLE EAR. 

bony structure and almost always with perforation and greater 
or less destruction of the drumhead. 

The patient with chronic catarrh does not often know when his 
trouble began; only by a gradually increasing hardness of hear- 
ing his attention is drawn to it. The grade of deafness depends 
not so much on the extension of the catarrhal affection as on its 
location, by which it is apt to interfere more or less with the con- 
duction of sound-waves to the labyrinth. A slight degree of 
catarrh, if it destroys the mobility of the fenestral membranes, 
causes greater deafness than a much more extensive catarrh, if it 
affects the walls of the middle ear or even the drumhead. 

Impaired hearing, when it is better in clear and dry and worse in 
damp and rainy weather; when it is momentarily relieved by 
Valsalva's or Politzer's method, or after an act of swallowing from 
which the patient perceives a kind of crack in the ear: when the 
own voice gives a more resonant sound, or the tuning fork on 
the vertex is perceived louder in the affected ear — it usually de- 
notes an affection of the Eustachian tube. When, on the contrary, 
under all these conditions, the degree of hearing is not altered, 
we may infer that the trouble is located in the articulations of 
the ossicula or in the fenestral membranes. A perforation of the 
drumhead is not necessarily attended with great impairment of 
hearing, even an entire destruction of the same does not cause 
entire loss of hearing; of greater importance in regard to hearing- 
are the changes from aural catarrh already referred to, which 
affect the articulations of the ossicula or the fanestral membranes 
on the labyrinth wall. The drumhead, if perforated, as a rule, 
heals kindly, but if it is kept open from continued inflammation 
and discharge, or even destroyed, the middle ear loses its protec- 
tion against external influences and is thus continually subjected 
to new irritations. 

Chronic otitis media suppurativa often leads to the formation 
of polypi and caries. Caries of the temporal bones may lead to 
abscesses in the brain or meningitis purulenta, to paralysis of 
the face, to haemorrhages, emboli, septic infection and phlebitis. 

Its Prognosis must be made according to these different char- 
acters and states. 

THERAPEUTIC HINTS.— Valsalva's or Politzer's method, or cath- 
eterism will prove beneficial in cases of imperviousness of the 
Eustachian tube, where it is important to procure a better venti- 



THE CHRONIC FORMS OF OTITIS MEDIA. 200 

lation of the middle ear, or in cases of perforated drumhead and 
copious collection of slime and pus in the middle ear, to cleanse 
it of these secretions. The main work even here will have to be 
done by carefully selected remedies. Besides those mentioned 
under the acute form of aural catarrh, compare: 

Arsen., profuse, ichorous, cadaverously-smelling discharge; sink- 
ing and prostration. 

Asaf., purulent discharge; after abuse of mercury. 

Auriim, fetid discharge; caries of mastoid process with pain 
like a bruise, worse at night, by uncovering and at rest; better 
by motion in the open air. Meatus externus lined by fetid pus, 
like decay of necrosed bone; drum perforated; ossicula destroyed ; 
middle ear denuded; fistulous openings through mastoid pro- 
cesses; offensive nasal discharge. Syphilis and abuse of mercury. 

Baryt. carb., in cases involving the external meatus, Eustachian 
tube ;?ud structures of the pharynx, especially tonsils. 

Baryt. mur. " has served me better than Baryt. carb. after long 
trials with the latter. Baryt. corresponds to an extra patency 
of Eustachian tubes caused by pharyngeal weakness or paresis. 
Clacking sound on swallowing, sneezing, or eructation, and by 
the two latter actions air is forced into the tympanum. Large 
tonsils reduced under its action." (Houghton.) 

Calc. carb., profuse discharge; chronic deafness; sensitive to 
shrill sounds; crackling sounds when chewing; singing in the 
ears with snapping as from electric sparks; roaring in the ears. 
Drumhead perforated; edges covered with granulations, extend- 
ing to external meatus; polypous growths. Sore eyes; sore, ul- 
cerated nostrils; smell of rotten eggs as gunpowder in the nose; 
nasal discharge; catarrh of Eustachian tube. 

Carb. veg., offensive discharge; aural meatus and drumhead 
inflamed ; pain from ear down to neck : after itch-like eruptions. 

Caustic, offensive discharge ; paralysis of face ; hardness of 
hearing; own voice reechos ; roaring and whizzing in ear; throat 
reddened, with increased mucus ; meatus dry, with little brown 
wax. 

Cinchona, haemorrhage from ear after prolonged suppuration. 

Conium, hardness of hearing ; ears stopped up by dark brown 
wax and pus ; pain in head ; ringing in ears ; enlarged liver 
with pain on pressure ; jaundice ; urine scanty, brown and bil- 
ious ; constipation, alternating with bilious diarrhoea ; cervical 
glands hard and tender. 
14 



210 THE MIDDLE EAR. 

Elaps, deafness; offensive, yellow-greenish discharge; buzzing 
in ears; frontal and occipital headache, worse from motion and 
stooping. Dull pain from nares to ears ; when swallowing, pain 
goes to the ears ; posterior wall of pharynx dry, mucous mem- 
brane fissured and covered with crusts; offensive discharge from 
nose ; subject to epistaxis and eruption about nose and face ; 
snuffles and pain from root of nose to forehead. Skin dry and 
hot, but always complains of feeling cold. 

Ferr. met, discharge from left ear ; chlorotic complexion ; im- 
paired hearing; murmur in left jugular vein; palpitation of the 
heart. 

Fluor, ac, hardness of hearing, with rheumatism ; ringing in 
the ears and numb feeling in the bones of the face, near the 
right ear. Hearing is better on bending the head backwards; 
scalp sensitive ; hair matting. 

Gelsem., deafness after massive doses of morphine or quinine. 

Graph.it, deafness ; hears better when riding in a carriage ; 
catarrh of right tube ; roaring in right ear ; feeling as if a skin 
were covering the ear inside; sensation as of a valve opening and 
closing in the ear; detonation and cracking in the ear when 
swallowing or sneezing; own voice resounds; roof of mouth and 
fauces red. Eruption behind the ears, with sticky secretion ; 
eczematous eruption of the face; mucous membrane of meatus 
red and excoriated ; or dry and scabby ; or oozing of water and 
pus, or blood ; or thin, watery offensive discharge from both ears 
after scarlet fever with deafness. 

Hepar, detonation in the ear when blowing the nose; drawing, 
tearing, stitching pain worse in night and cold air ; soreness of 
surface in spots when touched; skin ulcerates from slight injury; 
scabs behind the ears ; on ulcerated surface white shreds, which 
are removed with difficulty ; wants to be wrapped up warmly 
even if hot. Abuse of mercury. 

Jodium, deafness, with tonsillitis and catarrh of Eustachian 
tube ; indolent ulceration of the drumhead ; glandular enlarge- 
ment in front of the tragus ; pinched, dried-up look of the face. 

Kali bicnr., thick, yellow discharge, mixed with stringy mucus : 
sharp pain coming and going quickly and changing location : 
stitches from ear up into the head and down into the neck : bet- 
ter from heat. Naso-pharyngeal catarrh ; ropy mucus; "clinkers'" 
in nose. 

Kreosot, deafness with hereditary syphilis. 



THE CHRONIC FORMS OF OTITIS MEDIA. 211 

dryness of left ear; roaring and drumming in the ears; 
sense of coldness in the affected ear and side of head ; dry, scurfy 
condition of nostrils ; discharge of blood and pus from the nose. 

Lycop., external meatus excoriated by an offensive discharge ; 
drumhead destroyed. Patient cannot bear to be covered. After 
scarlet fever with affections of the parotid glands, eruptions, and 
abdominal troubles. 

Mercur., deafness : offensive discharge ; polypi ; external meatus 
and drumhead inflamed; itching in the ears; vesicular eruption 
in the face and itching pimples on legs. Syphilis. 

Merc, bijod., follicular catarrh in pharynx ; enlarged tonsils. 

Merc, dulc, " is more effective than the other forms of Mercur. 
in overcoming closure of Eustachian tube, and probably it is in 
this way that it relieves the deafness of advancing years." 
(Houghton). 

Merc, prsec. rub., purulent discharge ; leaden heaviness in occi- 
put ; falling out of hair. 

Mezer., deafness after the suppression of an eruption of the scalp 
characterized by the formation of crusts, beneath which, when 
pressed, oozed a purulent or semi-purulent fluid. 

Natr. carb., hardness of hearing and roaring in left ear with 
caries of the left molar teeth ; pain in left side of face; stiffness 
of neck and left shoulder ; pain in small of back and left leg, 
worse from motion, better in rest ; menses irregular, scanty ; all 
worse before the monthty. 

Nitr. ac, difficult hearing; obstruction of tube with swollen ton- 
sils after scarlet fever ; caries of the ossicula or mastoid process, 
from syphilis or abuse of mercury. Shooting pains; pain in 
bones, worse from every change of temperature, at night, on 
washing, on rising from a seat and from touch; better while, 
riding in a carriage. 

Phosphor., deafness to the human voice ; resounding of own 
voice; sensation as if a foreign body were lodged in the ear; 
great itching in the ears. 

Psorin., offensive discharge; offensive exhalation from whole 
body; itching in the ears; tinea capitis; scabs over fetid ulcers 
on and behind the ear. Similar to Sulphur but not reached by it. 

Pulsat, catarrh of Eustachian tube with hardness of hearing. 

Sepia, sensitive to musical sounds ; herpes on the lobe, behind 
the ear or on the nape of the neck. 

Silic, hardness of hearing, worse from washing and changing 



212 THE MIDDLE EAR. 

linen; otorrhoea and bad cough after scarlet fever; constant 
watery, curdy and ichorous discharge, without pain, except after 
a fresh cold. Ulceration, caries and necrosis ; pain drawing and 
shooting, worse at night, and from change of weather or move- 
ment; also after being long seated. Wants to have the head 
wrapped up. External meatus dry at outer portion, ulcerated 
farther in and at the drumhead. Child bores into its ear with 
its fingers when asleep, causing a discharge of blood and pus ; it 
enjoys having the ear cleansed. Feeling of sudden stoppage in 
the ear relieved by gaping or swallowing. "Silic. is specially 
curative in cases in which the ulceration covers with a firm scab, 
under which pus abounds. One subjective symptom I have 
found a guiding one: hissing sounds in the ear which is perfo- 
rated." (Houghton). 

Sulphur, deafness, especially for the human voice; purulent, 
offensive discharge, worse in damp weather, after meningitis. 
Drawing, shooting pains in the ears; pressure in the ears when 
swallowing or sneezing; ulcers in the middle ear; rusty ulcers 
on the drumhead. Frequent styes ; swollen nose ; eruptions on 
different parts of the body ; worms and itching of anus ; hot and 
.sleepless in the night; hot feet and burning of soles in bed with 
inclination to uncover the feet; disinclination to being washed. 

Thuja, discharge which smells like putrid meat; granulations 
in the middle ear similar to condylomata ; polypi. 

Polypi. 

These morbid growths are most frequently found in combina- 
tion with chronic suppurative catarrh of the middle ear. It is 
probable that in most cases they are the product of this morbid 
process, although it is possible, also, that, having originated pri- 
marily, they may by constant irritation cause inflammation, ulcer- 
ation and perforation of the drumhead. Their substance is very 
vascular, soft, red and easily bleeding when being touched; 
sometimes they are of greater consistence, have a smooth and 
shining surface, and grow grape-like on pedicles. Their size 
differs .greatly. From mere tiny excrescences they may increase 
to masses which fill the entire external meatus and even overlap 
it. They have been found to grow from the surface of the ex- 
ternal meatus, from the drumhead and from different parts of the 
surface of the middle ear. According to Von Troelsch their most 



THE CHRONIC FORMS OF OTITIS MEDIA. 213 

frequent origin is the middle ear; Toynbee and Wilde, on the 
contrary, observed them most frequently to originate on the pos- 
terior part of the external meatus. In regard to their histologi- 
cal nature, they are either a hyperplasia of the mucous lining of 
the middle ear — Mucous polypi — , or a proliferation of connective 
tissue — Fibrous polypi — , or a growth of a jelly-like substance — 
Gelatinous polypi. The first are the most frequent, the last the 
rarest form. < ,• 

THERAPEUTIC HINTS.— Alumen usta, 3d cent., " will reduce, granr 
Illation on the drumhead or inner extremity of meatus." (Hough- 
ton.) 

Calc. carb., large polypi, filling the whole external meatus and 
overlapping it; bleed occasionally; chronic nasal discharge. 

Calc. jod., offensive, thick, yellow discharge from the ear; deaf*- 
ness; pain in region of the heart, worse on going up stairs; fre- 
quent urging to urinate, as if the bladder were full, worse in 
afternoon and evening. 

Merc, sol., offensive discharge; polypi in external meatus, which 
is inflamed. ■. ■ • 

Sanguin., Teucrium. 

Thuja, large polypi with otorrhoea; bleed easily. Shooting- 
pain in ear. Granulations in middle ear. 

Nervous Deafness. 

Under this name a number of ear affections have heretofore 
been classed, which now are diagnosed as one or the other form, 
of chronic middle ear catarrh. Other affections still remain,, 
which must be favored with this title, until by further experi- 
mentation and improved means of diagnostic researches, we shall 
have gained a more precise knowledge of their nature. " Nervous 
deafness " comprises all those defects of hearing which take their 
origin in affections of the labyrinth, of the acoustic nerve and its 
origin, or of the brain. Various as these affections are and may 
be, we seldom have the means of accurately defining their nature 
during the life of the patient. We meet nervous defects of hear- 
ing after the abuse of quinine; in hysteria and chlorosis; in con- 
sequence of injuries to the head ; various affections of the brain. 



214 LABYRINTH. 

Meniere's Disease. 

The following are Meniere's observations : " 1. Attack of noises 
of various kinds, intermitting or continuous, and impairment of 
hearing coming on suddenly in heretofore well organs of hearing. 
2. These functional disturbances have their seat in the inner ear 
and are capable of producing apparent brain-symptoms, such as 
vertigo, stupefaction, uncertain gait, turning motions of the body 
and sudden falling down, attended with nausea or vomiting and 
fainting. 3. These attacks recur from time to time and are 
always followed by a higher or lower grade of deafness, even 
sudden entire loss of hearing. 4. It is most probable that the 
material change which lies at the bottom of these sudden dis- 
turbances, has its seat in the semi-circular canals." In one case 
post-mortem revealed an apoplectic effusion in these parts. This 
affection is also known under the name of Labyrinthine or Auditory 
vertigo, and according to Hinton is at times attended with uncon- 
scious divergence of the eyes and "seeing double" when inatten- 
tive. It seems, however, that not in all cases the primary affec- 
tion lies in the labyrinth. The same symptoms have been ob- 
served when in consequence of obstruction of the external meatus, 
or of catarrhal affections of the middle ear, with profuse exuda- 
tion, or with sudden stoppage of the Eustachian tube — an undue 
pressure is exercised upon the labyrinth. It is clear that in this 
case the prognosis is much more favorable than when the laby- 
rinth is originally affected. We can distinguish a primary affec- 
tion of the labyrinth from one secondarily caused by external 
pressure, by the suddenness with which it attacks without any 
premonitory symptoms, and by the absence of all obstructions, 
either in the external meatus or in the Eustachian tubes. 

THERAPEUTIC HINTS.— A case of suppurative inflammation of 
the labyrinth after cerebro-spinal meningitis is recorded by Dr. 
Searle. Total deafness ; straddling, gathering gait. Xo conduc- 
tion of sound of a heavy tuning-fork through forehead and head. 
Silic. 30 improved. Kali brom.^ cured. 

There are recommended by R. T. Cooper: Salycilate of Soda, Chin, 
sulph., Conium, Cicuta, Amyl nitr., all of which produce more or less 
deafness and vertigo, the leading symptoms of Meniere's disease. 

"Salycilate of Soda seems to correspond most closely to the 
usual symptoms and has served me better than any other rem- 
edy." (Norton.) 



TINNITUS AURIUM. 215 

The secondary form must be treated according to its causes, 
which compare. 

Tinnitus Aurium. 

Variable as sounds and noises, so also is the character of tin- 
nitus aurium. We might, however, discern two distinct groups 
of tinnitus aurium : 1, noises in consequence of an irritability of 
the auditory nerve, and 2, noises in consequence of irritation in 
or on the blood-vessels or adjacent parts of the hearing apparatus 
which the normal auditory nerve perceives. 

The first class — so-called subjective sounds or noises — are the 
consequence of cerebral disorders, as hyperemia of the brain, in- 
toxication by quinine or alcohol, faulty composition of blood in 
chlorosis, and exaltation or depression of the nervous system in 
general. But even here we may already have trespassed the 
proper boundary -line between the two groups ; irritation of the 
nervous and vascular system cannot be kept asunder, as the one 
is dependent upon the other. 

The second class — objective sounds or noises — are much more 
frequent and manifold in their causes. All kinds of irritations 
of the drumhead, or middle ear, or Eustachian tube, or labyrinth, 
either from circulation, inflammation, exudation, alteration of 
tissue, or foreign bodies, may give rise to it. Pulsating noises are 
probably mostly of a vascular origin ; ringing noises may be 
caused by clonic or tonic spasms of the muscles in the middle 
ear or of the Eustachian tubes ; the crackling noise in the ear 
during an act of swallowing originates by the contraction of the 
abductor tubes ; many other and various noises may be caused 
by vibrations of pus or dried scales of mucus, or by foreign 
bodies on the drumhead, or by the bursting of small bubbles of 
slime in the ears, when shaking the head, etc. 

Tinnitus aurium is often aggravated by worriment, mental 
and bodily depressions ; by sudden changes of weather, especially 
damp weather ; in illy ventilated rooms ; after sumptuous meals, 
the use of spirituous drinks and tobacco', and from bodily exer- 
tions if long continued. The patient usually feels better in the 
open air and in the company of friends, when a lively conversa- 
tion withdraws his attention from the constantly annoying 
noise, provided he hears well enough to participate in the con- 
versation and the room be not overheated or badly ventilated. 



216 NERVOUS STRUCTURE. 

Pressure with the finger upon the mastoid process or upon the 
first cervical vertebra changes and often ameliorates the noise in 
ears, while in many cases by reflex action an irritation of the 
trigeminus causes an irritation of the acusticus, so that many 
patients complain of an increase of the noise, as soon as they 
touch single parts of the face, or are being shaved. To this reflex 
action from the skin we must count also those aggravations 
which frequently take place in consequence of changing the 
linen, of standing with bare feet upon a cold floor and so on. 

Tinnitus aurium is, as may be seen from its various causes, 
often associated with various degrees of deafness. In chronic 
catarrh of the middle ear a continuous noise is an unfavorable 
sign. Sometimes tinnitus and deafness increase and decrease in 
like proportions ; other times tinnitus increases as the deafness 
decreases. 

THERAPEUTIC HINTS.— It is obvious that special hints cannot 
be given. We must necessarity in each case consider its cause, 
for which the necessary hints will be found in the foregoing 
chapters. Tinnitus, however, may in some cases by its peculiar- 
ity hint to a remedy by which the entire aural affection may be 
removed. Here I must refer to our repertories and Materia 
Medica. 

Otalgia Nervosa 

Is a hyperesthesia of the sensible nerves of the ear, and must not 
be confounded with the pain caused by inflammatory processes 
in the ear, as met with in otitis media. It is of much rarer oc- 
currence than otalgia accompanying otitis. It characterizes itself 
frequently by its typical course. Often it is associated or caused 
by caries of a molar tooth on the same side, or by ulceration of 
the epiglottis, as a reflex action of the vagus. 

THERAPEUTIC HINTS.— Compare facial neuralgia, toothache, etc. 

Plant, maj., "is our sheet-anchor for otalgia independent of or- 
ganic lesions." (Houghton.) 

Sodium seleniate^, has just relieved a pure otalgia of years stand- 
ing. (Norton.) 



NOSE 



General Observations. 

1. Concerning the indications from its form and shape. 

A thick, swollen nose is either a sign of inflammation (if accom- 
panied by pain, heat and redness) or of rhachitic and scrofulous 
diseases. Lovers of intoxicating drinks are generally blessed 
with a suspicious looking nose of such shape. 

The nose becomes pointed, pinched, during spasms; during a 
chill, and in collapse. 

When in children the nose becomes suddenly pointed, it is a sign 
of impending spasms; an habitually pointed nose denotes de- 
rangement in the mesenteric glands, and general atrophy. 

If the nose becomes pointed suddenly during the act of parturi- 
tion, it is a sign of internal hsemorrhage, or complete exhaustion, or 
threatening convulsions. 

The pointed nose of a nursing mother indicates her complete 
unfitness for being wet-nurse. When it sets in suddenly in severe 
illness, it is always a bad symptom ; being a sign of extreme ex- 
haustion and collapse. A heavy motion of the nasal wings during 
respiration is a sign of impeded respiration, either from asthma, 
pneumonia, croup, dropsy in the chest, or incipient paralysis of 
the respiratory muscles, and utter prostration. 

2. In regard to color. 

A red nose may result from a variety of causes : extreme cold 
air, congestions, crying, being overheated, cold in the head, 
worms, scrofula, intemperate use of ardent spirits. In young girls 
it denotes the setting in of menstruation. 

Circumscribed redness of the point of the nose, of the cheeks, and 
of the forehead, with paleness and coldness of the other parts of 
the face, denote, in pneumonia, that suppuration has taken place. 



218 NOSE. 

A coppery shining redness of the root of the nose is a sign of exist- 
ing syphilitic ulcers within the nose. 

TJie copper nose of wine and liquor drinkers is well known. 

A pale nose is found in various morbid affections ; during a 
chill, during syncope, in spasms from nausea, after great exer- 
tions, from sexual excesses, profuse haemorrhages, and so on. In 
women it is a sign of approaching menses or disturbed menstrua- 
tion ; profuse leucorrhcea ; chlorosis. During pregnancy it is a 
sign that the foetus is dead. In eruptive fevers it denotes a dis- 
turbance in the exanthematic process and probably metastasis to 
internal organs. 

A grayish, lead-colored nose is found in dropsy of the chest and 
pericardium, in induration of the lungs and some malignant 
typhoid fevers. 

Single lead-colored stripes have been observed in obstinate ob- 
struction of the portal vein. 

A bluish color of the nose is found in some cases of apoplexy ; in 
croup, in catarrhus suffocativus, in diseases of the lungs, heart 
and larger blood-vessels; in short, in all morbid conditions 
which cause a stagnation of blood, cyanosis. 

Brownish, yellowish spots on and over the nose, like a saddle, 
indicate mostly a diseased liver or chronic leucorrhcea, 

A blackish fur at the nostrils is found in typhus, epidemic dysen- 
tery, cholera, altogether in conditions of great prostration. 

3. In regard to temperature. 

A hot nose we find in violent coryza, inflammation, before 
bleeding, during delirium, sopor, apoplexy. 

Coldness of the nose we find during a chill, spasms, nausea; from 
loss of blood, exhaustion, and in consequence of inflammation 
of the bowels. 

An habitually cold nose is found in disordered states of the ab- 
dominal viscera, in dropsical complaints and in chlorosis. 

To all this I have to add one more pathognomonic sign: 

The constant picking and boring at the nose, which is found fre- 
quently in consequence of irritation in the intestinal canal from 
worms, or in typhoid fevers and cerebral affections. In these 
latter cases there is always a want of natural secretion in the 
nose; it is as dry as a powder-horn; its getting moist again is one 
of the most favorable signs in such cases. 



EXAMINATION OF THE CAVITY OF THE NOSE. 219 

Examination of the Cavity of the Nose. 

In order to get a full view of the Anterior nasal cavity, it is 
necessary to dilate the nostrils. This is best done hy means of 
Fraenkel's or Von Troeltsch's speculum narium, instruments 
which after being introduced into the nose can be made to ex- 
pand so as to push off the side walls of the nose from the sep- 
tum. If we now place the patient in a position where the direct 
rays of the sun fall into the dilated nostrils, or in the absence of 
sun-light, concentrate by a reflector the rays of candlelight or 
diffused daylight into the nasal cavity, we will be able to see 
the entire anterior part of it, from the superior turbinated bone 
to the floor ; the anterior portion of the middle turbinated bone ; 
the anterior and inferior surface of the inferior turbinated bone ; 
the surface of the septum, and in many cases the posterior wall 
of the pharynx through the inferior meatus. The turbinated 




bones appear in a normal state as pale, red protuberances, cov- 
ered with mucus. Any alteration from the normal color, any 
swelling or hypertrophy, or change in configuration, the amount 
of secretion, the presence of ulceration, etc., will thus be admitted 
to our view. 

In order to get a view of the Naso-pharyngeal cavity and the 
Posterior portion of the nasal cavity, we must inspect these parts 
through the pharynx. For this purpose we need a tongue spa- 
tula, a reflector and a pharyngeal mirror which, in some 
cases, may be substituted by an ordinary laryngoscopic mirror. 
The tongue may be held down with the spatula by the patient 
himself, if he be intelligent enough, after the physician has de- 
pressed it in a manner that it cannot obstruct our view and still 
remain behind the lower incisor teeth. Free passage being thus 
provided the physician "introduces the mirror into the pharynx 
by passing it as closely as possible over the lower teeth and 
along the back of the tongue in the median line, until it is in 



220 NOSE. 

the free space between the base of the tongue, the laryngeal 
opening, the posterior wall of the pharynx, and the velum pala- 
tinum. It should not stand directly in the median line, on ac- 
count of the uvula, which would lie in front of it and obstruct 
the view, but rather on the right or the left side, under one or 
the other of the arches of the soft palate, with it's upper edge 
brought close to the posterior wall of the pharynx. The problem 
to be solved in introducing and placing the mirror is, not to 
touch the patient." — (Fraenkel.) This requires practice, and it 
is not an easy matter to handle the instrument in such a man- 
ner as to receive clear pictures from the parts above and behind 
the velum palati. The illumination is best achieved by a re- 
flector fixed upon the forehead of the examiner, as mentioned 
under the examination of the ear. If successful in our opera- 
tions, we will see posteriorly in the rhinoscopic picture the 
fornix pharyngis or vault of the pharynx, which is attached to 
the base of the skull; its surface is covered with ridges, running 
irregularly, and its structure consists of a dense adenoid tissue, 
on which account this region is called tonsilla pharyngea. Later- 
ally we will see the recessus pharyngei, or the fossa of Rosen- 
muller, from which anteriorly rise on either side the pharyngeal 
openings of the Eustachian tubes. In front and above we see 
the posterior nares, the septum, the posterior portion of the 
middle turbinated bone, and part of the middle meatus of the 
nose. With the exception of the septum, the mucous membrane, 
covering the walls of this region, has a fresh red color ; the tur- 
binated bones, usually covered with more or less mucus, appear 
as steel-gray or yellowish-red protuberances. The erectile bodies 
found on the posterior portion of the turbinated bones frequently 
lead to sudden swellings. Further down we see the posterior 
surface of the velum, on the sides of which run downward and 
inward two folds of mucous membrane. 

Catarrh, Coryza, Cold in the Head. 

Catarrhal inflammation of the mucous membrane, lining the 
nasal cavity, is characterized by redness and swelling of this 
membrane, and a discharge from it, which at first is watery and 
lastly becomes muco-purulent, therefore the name Catarrh, mean- 
ing a flowing down, nameby of impurities from the head according 
to the Ancients' idea of this trouble. It is usually preceded by a 



CATARRH, CORYZA, COLD IN THE HEAD. 221 

feeling of lassitude and chilliness, and a sensation of weight and 
pressure in the head, which latter symptom gives rise to the 
name of Gravedo or Coryza, while Cold in the head expresses its 
principal cause. The hyperaemic state of the mucous membrane 
is at first attended with prickling and dryness of the nose and a 
frequent disposition to sneeze ; then follows the discharge, at first, 
as mentioned above, watery and by-and-by muco-purulent. If 
mild, the morbid process may end with this. But often it spreads 
from the mucous membrane to the epidermis, inflaming the nose 
wings and upper lip, or may even provoke erysipelatous inflam- 
mation of the face; or it spreads upwards into the frontal sinuses; 
or through the lachrymal duct to the lachrymal sac and the con- 
junctiva; or sideways into the Highmorian cavities; or back- 
wards into the retro-nasal cavity, where it not unfrequently affects 
the Eustachian tubes, causing ringing in the ears, difficulty of 
hearing, etc.; or it extends downwards into the larynx, trachea 
and bronchial tubes producing cough, or diarrhoea when it affects 
the mucous lining of the intestines. Nasal catarrh is often at- 
tended with neuralgia of the fifth pair of nerves. 

Coryza occurs sporadically and in the form of an epidemic. There 
is no doubt that some persons show a decided predisposition to it. 
Taking cold by means of sudden changes in the temperature, or 
exposure to sudden cooling of the surface after being heated, is 
one of the principal causes of this affection, but also irritants of 
various description, vapors of iodine or acrid gases, or the pollen 
of plants, compare " hay fever," are fruitful sources of this com- 
plaint; we find it also associated with the initial stage of measles, 
while typhoid fever and scarlatina exclude it. The epidemic 
form seems to have its cause in peculiar (unknown) states of the 
atmosphere — deficiency or superabundance of ozone? 

"The question of the contagiousness of coryza must, in spite of 
the negative result of inoculation, be considered as one and the 
same with the question of the contagiousness of catarrhal or puru- 
lent secretions in general, and in the light of clinical observa- 
tions must, for the present, be answered in the affirmative, espe- 
cially as regards purulent secretions." (Fraenkel). 

The duration of a simple catarrh is usually from two to three 
days. Complicated cases last much longer. An acute attack if 
neglected, or if dependent on some dyscrasia, may run into the 
chronic form. 

The Purulent nasal catarrh, or Nasal blenorrhcea, characterized by 



222 nose. 

its purulent secretion, we find often in new-born children, as the 
consequence of infection by the leucorrhoeal discharge of the 
mother ; it may be caused also by the action of gonorrhoeal mat- 
ter; it develops itself during the course of scarlet fever or variola, 
in diphtheria and in consequence of cauterizations of the mucous 
membrane. It is a much graver form than simple catarrh and 
may also lead to chronic catarrh. 

THERAPEUTIC HINTS.— Aeon., in the commencement, dry state; 
from cold winds. Headache, sneezing; running, of the nose; 
watering of the eyes; roaring in the ears; flushed face; thirst; 
scanty, hot urine ; dry, short cough with crying; accelerated pulse 
and breathing ; hot, dry skin ; sleeplessness or dozing with 
starting. 

Amm. carb., stoppage, especially at night; acrid, watery, burn- 
ing discharge; congestion of blood to tip of nose when stooping. 

Amm. mur., coryza with stoppage ; great soreness and tenderness 
of nose ; loss of smell. 

Anac, fluent ; frequent sneezing ; sense of smell acute, or illu- 
sory like pigeon dung or burning tinder. 

Aral, rac, coryza with frequent sneezing, soon followed by 
asthma; excessively sensitive to slightest depression of tem- 
perature. 

Arsen., burning, excoriating, watery discharge, with a feeling of 
being stopped up ; or stoppage alternating with running of nose 
and burning. Cold worse in morning with throbbing headache; 
frequent sneezing ; hoarseness; rawness and burning in throat; 
tickling in throat-pit and dry cough at night. Nosebleed; pale 
face; great thirst; sleepless and restless; lassitude. Great incli- 
nation to catarrhal affections. 

Arum triph., discharge of burning, ichorous fluid, excoriating 
nostrils, upper lip and corners of mouth. Stoppage. Constant 
boring and picking at nose and lips. 

Asar., fluent coryza with deafness and sensation as if the ears 
were plugged with something. 

Bellad., watery and acrid discharge with burning in nose ; or 
dryness of nose with acute or dull smell ; frequent sneezing 
which painfully shakes the head; erysipelatous redness and 
swelling of the nose with chilliness and heat in the face: intense 
redness of face ; severe throbbing headache ; dull pain in frontal 
sinuses ; hallucinations or delirium with injection of conjunctiva, 



CATARRH, CORYZA, COLD IN THE HEAD. 223 

photophobia and lachrymation. Great dryness in fauces; diffi- 
culty of swallowing; soft palate inflamed and glistening; tonsils 
swollen. Children either cry continually and nothing seems to 
please them, or they are drowsy, apathetic and desire nothing; 
grown persons are either very sensitive to slightest noise, excited, 
or stupefied. Worse afternoon and evening. 

Bryon., extending into frontal sinuses or chest; stitch-pain. 

Calc. carb., sudden colds with dropping of clear water from the 
nose in spells; mouth dry, fauces rough; heat and dulness of 
head; frequent and profuse urination ; great liability to catarrhs 
in scrofulous children; stoppage of nose. 

Camphora, fluent coryza with chillness at the commencement; 
thin, sallow, nervous, sensitive people with cold hands and feet. 

Cepa, profuse watery discharge with sneezing, excoriating nose 
and lip; itching, burning and stinging in eyes; flow of tears; 
headache. Worse in evening and warm room ; better in open 
air. Laryngeal cough with pain as if the larynx would be torn. 
North-easterly storms. 

Chamom., chilly, feverish; thirsty; one cheek red, the other 
pale; rattling cough. 

Cyclam., sneezing and profuse discharge; loss of smell and taste: 
pain in head and ears. 

Eupat. perf., hoarseness; cough worse in the evening; aching in 
all the bones. 

Euphras., profuse discharge of mild mucus; upper lip stiff as if 
of wood; eyes inflamed and full of acrid tears; cough only 
through the day. 

Grelsem., summer colds with violent sneezing in the morning ; 
edges of nostrils red and sore; pharyngeal inflammation with 
pain on swallowing, shooting up into the ear; deafness. Hands 
and feet cold in p.m.; then drowsy; fever until morning; half 
waking and talking in sleep during night. Disposition to catch 
cold at any change in the weather. 

Hepar, nose swollen and red, sensitive to touch ; blowing the 
nose causes whizzing and snapping in the ear, and a raw feeling 
inside of nose; feverish and sensitive to cold air; wants to be 
covered, even when hot, When fluent coryza suddenly stops 
and is followed by hoarseness and croupy cough. Disposition to 
taking cold after the abuse of mercury. 

Hydrast, posterior nares clogged with mucus; obstruction of 
nasal passages; frontal headache. 



224 nose. 

Iodiura, glassy mucus; watery discharge at night, with sneezing; 
stoppage worse in evening; loss of smell. Eustachian tubes 
affected with dulness of hearing and noises in the ears. 

Kali bichr., a sense of tight pressure at the root of the nose, and 
dull, heavy headache in forehead, better from pressing tightly 
the bridge of the nose; discharge is acrid, excoriating nose and 
lip. Worse in warm, better in cool temperature. 

Kali hydr., inflammation of Schneiderian membrane, extend- 
ing to frontal sinuses, Highmorian cavities, lachrymal ducts and 
fauces. Nose red and swollen; discharge watery, acrid, continu- 
ally, with violent and painful sneezing. Eyelids swollen, con- 
junctiva injected; lachrymation. Sticky pain in ears. Red face, 
with anxiety and restlessness; hammering pain in forehead with 
a sensation as if the head were compressed from both sides, or 
enlarged three times its size. Frantic excitation; fever, with 
great thirst, hot, dry skin, alternating with drenching sweat; 
heat preponderates with intermitting shuddering, and dark, hot 
urine. 

Laches., profuse discharge' of a thin, watery slime; soreness of 
nostrils and lip; preceded often for a few days by a feeling of 
soreness, rawness and scraping in the throat. Violent headache 
in forehead, when the discharge suddenly dries up. 

Lycop., inflammation of frontal sinuses with tearing headache, 
worse evenings; nightly stoppage, with breathing through the 
mouth. 

Merc, sol., sneezing and dropping of watery fluid from the nose, 
which is swollen, red and sore. Inflammation of eyes, frontal 
and Highmorian cavities, of larynx, trachea and bronchi, of ton- 
sils and fauces. Profuse sweat at night, not relieving. Rheu- 
matic pains, worse in the night; in warmth and in cold. Epi- 
demic form or common colds. 

Nux vom., ordinary colds at the commencement; when dry 
or fluent only through the day and stopped up at night; tingling 
in nose, scraping in throat; heat in head and pain in forehead; 
hot and feverish and chilly on moving. Smell as of old cheese, 
sulphur or tinder; constipation. Colds of new-born children. 

Phosphor., frequent alternation of fluent and dry coryza; ob- 
struction often in the morning; or discharge from one and stop- 
page of the other nostril ; sneezing causes pain in throat or head 
and constriction of chest. Fauces feel raw and burning and 
appear dry and glistening. Hoarseness and bronchial catarrh. 
Smell and taste gone. 



CHRONIC CATARRH, OZiENA. 225 

Phytol., flow of mucus from one nostril, while the other is 
stopped; total obstruction of nose when riding. 

Pulsat, at the commencement, when dry and fluent alternately, 
or stopped up in the evening, with loss of smell and taste and 
appetite; thirstlessness; chilliness; or later with profuse, thick, 
yellow or greenish discharge, nosebleed. Conjunctiva inflamed; 
pressure at root of nose; tearing in Highmorian cavity extending 
to ear. Dry cough at night when lying clown, better on sitting 
up; stomach ache; slimy, painful diarrhoea. All symptoms are 
worse in the evening and in a warm room; better in open air. 

Rhus tox., thick, yellowish discharge; eczema on both sides 
below nose; nose swollen and now and then bleeding. Aching 
in all the bones, worse in rest. 

Sanguin., pain over root of nose; eyes sore to touch; sore throat; 
cough, and finally diarrhoea. 

Sepia, profuse and mild discharge, coming on suddenly, com- 
bined with rheumatic pains in the limbs and intense occipital 
headache. 

Spigel, copious discharge, badly tasting and smelling; flows 
during night from posterior nares down into the throat, and 
causes choking. 

The snaffles of infants require : 

Amm. carb., when the child in the act of going to sleep starts up 
again on account of not getting any breath. 

Chamom., Nux vom., Pulsat. 

If of a syphilitic nature, compare Chronic Catarrh. 

Chronic Catarrh, Ozaena. 

An acute attack may in consequence of bad management or 
neglect become chronic, especially its purulent form, or when 
there is a scrofulous or syphilitic dyscrasia in the person. At 
first " the mucous membrane becomes thickened and livid," later 
it seems to shrink, " becomes thin and pale, apparently consisting 
of connective tissue and blood-vessels alone, and hardly worthy 
the name of mucous." "The epithelial cells are partly destroyed 
or they become turbid, and the mucous membrane, losing its 
natural lustre, appears opaque and uneven." 

The secretion is generally of a purulent character, profuse or 
scanty. Often it forms crusts, which adhere firmly to the mem- 
brane underneath ; their color is frequently of a greenish cast, or 



226 nose. 

they are mixed with blood. And when the secretion undergoes 
a specific decomposition, a peculiar, penetrating stench is pro- 
duced, which is communicated to the expired air. From this 
symptom the complaint has been called Ozsena, or Stinknose. 
Mostly ozsena grows on a dyscratic soil, although cases occasion- 
ally occur without either syphilis or scrofula being present. 

Chronic catarrh is prone to frequent acute exacerbations. It may 
assume a suppurative character, destroy the periosteum and cause 
caries; or it may lead to polypoid excrescences. It may spread 
to the frontal and Highmorian cavities, or to the skin surround- 
ing the nostrils, causing excoriations of upper lip and infiltration 
of the cervical glands. It usually is attended with loss of smell, 
either partial or total, and its annoying and intractible character 
is well known to both patient and physician. 

THERAPEUTIC HINTS.— Agar., profuse fetid discharge; accumu- 
lation of mucus in nose, with sensation as if the nose were 
entirely filled with it ; bad smell from mouth. 

Alum., soreness and scabs in the nose ; thick, yellow mucus. 

Ant. crud., on inhaling cold air, it feels as if it went over a raw, 
very sensitive surface. Nostrils crusty, and corners of mouth 
cracked and sore. 

Arg. nitr., discharge of pus with clots of blood. Chilliness, 
lachrymation and stupefying headache. Violent itching of nose. 

Asaf., greenish, offensive discharge. Mercurial complication. 

Airnim, nose inflamed ; nasal bones sore to touch ; caries of 
nasal bones; fetid discharge; nostrils ulcerated and agglutinated; 
whole nose painful, worse at night. Mercurial and syphilitic 
complication. 

Aur. mur., small, painful sores inside of nose; blowing out of 
blood ; mucus from head to throat ; headache ; constipation ; 
haemorrhoids. 

Baryt. carb., scabs form in posterior nares and behind the uvula. 

Berber., extending to antrum Highmorianum, especially left 
side. 

Calc. carb., purulent discharge fetid, thick, yellow -reddish, 
making lip sore ; slimy discharge through the day, with sensa- 
tion of stoppage ; stoppage and dryness at night ; stoppage worse 
in morning on getting awake. Xose swollen, especially at root ; 
soreness on edges and septum, also ulceration ; upper lip swollen. 
Smell dull, or like rotten eggs, dung, or gunpowder. Hoarseness 



CHRONIC CATARRH, OZ.EXA. 227 

in morning; rough voice which improves from hawking. Scro- 
fula. 

Corall., discharge resembling molten tallow. Profuse secretion 
of mucus through the posterior nares, obliging to hawk fre- 
quently. 

Cuprum, affection of frontal sinuses, with pain in forehead, 
worse over left eye and root of nose, worse from motion, better 
when lying. Nose feels stuffed and yet sometimes discharges 
yellow and again watery matter. Smell gone ; taste imperfect. 

Curare, fetid lumps of pus; scanty menses; pain in os uteri; 
slight, watery, starchy leucorrhcea. 

Elaps., partial stoppage and stuffiness high up in the nostrils, 
with dull-aching to forehead; worse in Avet weather, occasionally 
bad smell from the nose ; offensive discharge ; posterior wall of 
throat covered with a dry, greenish-yellow scab, wrinkled and 
fissured, extending up to nose ; occasional nosebleed ; pain from 
root of nose to ears on swallowing ; sneezing at night ; sense of 
smell gone; profuse and dark catamenia. 

Graphit., stoppage with secretion of tough, fetid slime ; stoppage 
with periodical attacks of fluent coryza of short duration ; hard 
masses of slime, or crusts in nose; purulent, fetid discharge worse 
during the menses; bloody discharge.; smell as from an old cold 
in nose, or as of burnt hair ; ulcerative nostrils ; moist eruption 
behind the ears ; eruptions around anus and genitals. Great in- 
clination to take cold. 

Hepar, nose extremely sensitive to touch; swollen and red; the 
nostrils feel raw after the discharge of mucus ; the interior of the 
nose is sensitive to air. 

Iodum, fetid discharge ; nose swollen and painful. Scrofula. 

Kali bickr., constant snuffing in warm, damp weather; discharge 
of crusts slightly tinged with blood ; perforating ulcers on septum ; 
ulceration of mucous membrane; ulceration of frontal sinuses 
with violent pain in that region, if discharge stops. Fetid smell 
from nose ; loss of the sense of smell. 

Kali carb., obstruction worse in the room, better in open air ; 
yellow-green or bloody discharge ; or purulent and fetid from 
one nostril ; crusts closing the nostrils ; collection of mucus in 
throat and feeling of a lump in the throat ; convulsive and tick- 
ling cough at night with choking and gagging, especially in 
the morning; rheumatic and gouty symptoms. 

Kali hydr., syphilitic origin after abuse of mercury with pain in 
shin bones, especially at night. 



228 nose. 

Lycop., stoppage at night, breathing with open mouth ; " dis- 
charge of elastic plugs ; " catarrhal headache and despondency. 

Merc, prot, " dark redness of the fauces ; elongation of the palate, 
with collection of mucus behind ; enlargement of the tonsils, 
which are sometimes covered with yellowish or whitish patches, 
small in size ; collection of tough, yellow mucus in the posterior wires 
which partially drops into the throat, causing constant inclination to 
hawk and spit in order to clear the throat and nose." (Fisher.) 

Natr. carb., profuse discharge of thin, white mucus; or thick, 
yellow-greenish, musty smelling mucus, ceasing after a meal, or 
at night; stoppage of nose at night. Worse from exposure to 
slightest draught, or when removing an article of clothing. Loss of 
smell and taste. 

Natr. mur., stoppage high up in nose, with sudden dribbling at 
times of clear water from nose ; posterior nares feel dry in the 
morning, with scraping in larynx and rough voice. Continual 
lachrymation from obstruction of the nasal duct; roaring and 
buzzing in the ears and head with inability to work, read, or 
think. Loss of smell and taste. 

Nitr. ac, often mucous discharge only from posterior nares ; red, 
scurvy tip and nostrils, feels like splinter on touching it ; fetor. 
Mercurial poisoning. 

Petrol., obstruction of posterior nares; copious collection of 
slime in the fauces with a feeling of dryness. Eustachian tubes 
obstructed, with whizzing, roaring and cracking in the ears ; 
hardness of hearing. Bad smell from mouth. 

Phosphor., discharge yellow, or yellow-green, or bloody; nose 
swollen and sore to touch ; nostrils ulcerated. In scarlatina, with 
swelling of neck and staring eyes, icy cold and bluish hands ; dis- 
charge flows down into the throat on lying. 

Psorin., great fetor; bad smell of all secretions and excretions. 
Intractible cases where other remedies have failed. 

Pulsat, thick, yellow or green and fetid discharge; nose swollen 
and itching in the evening; wings ulcerated; oozing of watery 
fluid from nose; loss of smell and taste. Young girls with menses 
too late, scanty and pale, followed by leucorrhcea ; chilliness, in- 
termingled with heat. Timid, whining mood; disposed to inter- 
nal vexation and grievance; mild, yielding disposition; slow, 
phlegmat ic temperament. 

Sepia, greenish crusts with bloody borders; eczema behind the 
ears; symptoms of portal congestion. 



INFLUENZA, GRIPPE. 229 

Silic, secretion tough, slimy, purulent ; stoppage in the morn- 
ing followed hy hawking of thick, green-yellow, fetid masses after 
getting up. Acrid water from nose making it sore and bloody; 
septum sore, and smarting crusts high up in nostrils; frontal 
sinuses inflamed with pounding and throbbing pain in forehead; 
fauces dry and painful ; uvula swollen ; Eustachian tubes itch- 
ing; chronic inflammation of tonsils and swelling of submaxil- 
lary glands. 

Sulphur, slimy, acrid discharge with burning in eyes and upper 
lip ; or dryness of nose like parchment and a feeling of stiffness 
of the nose followed by discharge of thick, bloody slime and then 
again dryness with sneezing. Inclination to draw the phlegm 
down through posterior nares. On blowing the nose the ears feel 
obstructed, or it feels as if air were entering the ears. Soreness 
inside of nose and of septum. The interior of nose is sensitive to 
the inhalation of air in a warm room ; not in open air. 

Besides compare therapeutic hints under acute catarrh. 

Influenza, Grippe. 

It is an epidemic disease characterized by a series of catarrhal 
manifestations, attacking the respiratory, and generally also the 
digestive organs, and is attended by great and rapidly developed 
weakness, pains in the limbs, severe headache, serious nervous 
symptoms and more or less fever. It attacks all persons without 
distinction of age, sex or occupation: atmospheric conditions and 
local circumstances, such as elevation, condition of soil, etc., are 
not known of exercising any particular influence upon its spread ; 
in short, exciting causes are not known. The assumption of its 
contagiousness has been abandoned just as often as it has been 
established. It spreads rapidly in its local diffusion, advances 
comparatively slowly on a grand scale over countries and seas 
without being essentially influenced by human intercourse or the 
direction of the wind; in other cases it remains limited to narrow 
circuits, while at still other times it appears simultaneously at 
different points of the earth's surface or attacks districts far re- 
moved from one another with inexplicable leaps. 

Its Diagnostic difference from a common epidemic catarrh 
lies in its marked march of progression and its independence of 
weather and season, while from a commencing typhoid fever it 
differs by its persistent elevation of temperature and the absence 



230 NOSE. 

of enlargement of the spleen and rose spots, the moderately fre- 
quent pulse, etc. It is not a very fatal disease; but as it modifies 
and complicates all other existing diseases, it is especially hard 
on the weak and also on the aged; a tuberculous disposition is 
often ripened by it into full bloom, and chronic bronchial ca- 
tarrhs are not unfrequent sequelae of its visitation. 

THERAPEUTIC HINTS.— An epidemic is usually manageable 
by one or a few remedies, but different epidemics require differ- 
ent remedies, as the genius of their combination is an ever 
changing one. To detect the specifics for a prevalent grippe, a 
comparison of the hints given above under catarrh may be of 
help ; the following are additional hints. 

Aeon., dry cough and stitches in chest. 

Arsen., cough and all symptoms worse after midnight; great 
thirst, great restlessness and great debility. 

Bellad., cerebral symptoms ; drowsiness ; starting in sleep ; de- 
lirium when shutting the eyes ; wants to sleep and cannot sleep. 
Severe headache; dryness in mouth and throat; spasmodic 
cough. 

Bryon., pain in all the limbs, worse from motion ; cough, with 
pain in pit of stomach, around the short ribs and in chest; affec- 
tion of liver. 

Eupat. perf., severe backache, or bone-pains, with bilious symp- 
toms. 

Gelsem., feels "played out," feverishness, catarrhal running from 
nose, collection of mucus in throat; pain in throat up to ear 
when swallowing ; cough. 

Laches., feels worse after sleep ; fever worse in the afternoon ; 
sweat without relief. 

Mercur., rheumatic pains not relieved by sweat ; flabby tongue, 
with imprints of teeth ; diarrhoea ; boiling heat from pit of 
stomach over the entire body. 

Nux vom., fever-heat with chilliness by slightest motion ; dull, 
heavy headache ; vertigo ; hard cough ; sour taste ; nausea and 
vomiting ; belching ; pain in chest ; constipation. 

Phosphor., bronchial affection with dry cough, tightness of 
chest, worse before midnight ; great debility. 

Pulsat, evening aggravation; loss of appetite; bitter taste; 
diarrhoea ; chilliness. 

Rhus tox., great aching in all the limbs, worse in rest ; great 
restlessness ; red tip of tongue ; typhoid symptoms. 



YEARLY COLD, ROSE COLD, HAY FEVER, HAY ASTHMA. 231 

Sabad., lachrymation in open air, when looking at a bright 
light, when coughing or yawning. Sleepy in daytime; chilli- 
ness, with heat of face ; cough on lying down. 

Sanguin., smell in nose like roasted onion ; wheezing-whistling 
cough and finally diarrhoea, which relieves the cough. 

Tart, emet, shaking, loose cough, with oppressed breathing, 
which is relieved by expectorating ; gastric symptoms. 

Yearly Cold, Rose Cold, Hay Fever, Hay Asthma. 

It is a slight febrile catarrh, which affects the conjunctiva, the 
mucous membrane of the nose and upper air-passages, and fre- 
quently, but not always, is attended by asthmatic difficulties, 
which sometimes are of great intensity. It attacks only people 
peculiarly disposed to it, and regularly recurs every year when 
the roses bloom (rose cold), or when hay is made (hay fever, hay 
asthma), during the months of May till September (summer ca- 
tarrh). In regard to its Exciting Causes we glean from Black- 
ley's careful experiments the following: A thorough observation 
of atmospheric conditions showed that the attacks do not run at 
all parallel with extremes of light and heat. Ozone, benzoic acid, 
and cumarin produced only a very unimportant influence upon 
the respiratory organs and none which resembled the symptoms 
of hay fever. Dust, which, besides, is differently constituted in 
different regions, may occasion cough and catarrhal symptoms at 
various seasons ; but these have little similarity to hay fever, and 
are not at all confined to the summer season. The fragrance of 
flowers of various kinds has little effect, although the smell of 
chamomilla matricaria produces disagreeable symptoms, head- 
ache, etc. The effect of spores of penicillium glaucum was hoarse- 
ness, increasing to aphonia, bronchial catarrh, etc., which lasted 
for some days. On the other hand there has been complete suc- 
cess in developing the features of hay fever by the operation of 
pollen upon the organs of respiration, and it is therefore a cer- 
tainty that the exciting cause of hay fever must be ascribed to 
the pollen, fresh or dried, of different plants, especially grasses 
floating in the air. For this reason the attacks are milder in- 
doors than in the open air, and may be prevented altogether by 
removing to regions which are free from this exciting cause. 

THERAPEUTIC HINTS.— Hay fever being the result of irritation 



232 nose. 

of the Schneiderian membrane by the pollen of different plants, 
especially of grasses, it can be mitigated by a. sojourn at the sea- 
side, especially an island or a narrow peninsula, where the air is 
least pregnated by such pollen. A sea-voyage prevents it alto- 
gether. High mountain air is also nearly free of these exciting 
causes, as are the centres of large cities, where the patient feels 
best on keeping in-doors. A number of remedies have been tried 
and some found beneficial. They are: Ailanth., Arsen., Arum 
triph., Camphor, Cyclam, Euphorb., Euphras., Gelsem., Grlanderin, Grin- 
delia, Hydr. ac, Ipec, Iodum, Kali bichr., Kali hydr., Laches., Lobel., 
Merc, com, Merc, sol., Moschus, Natr. carb., Natr. mur., Phosphor., 
Pulsai, Sabad., Silic, Sticta pulm., Tart, emet., Tax. bacc., Zincum. 
Their special applicability must be studied from the hints under 
nasal catarrh and asthma. 

Naja trip., hay fever after sneezing stage and asthmatic trouble 
remaining. In asthma when all other medicines had failed to 
touch, and had been well nigh abandoned. (M. Preston.) 
Arum mac. 30 , in water, " until the throat troubles are better." 
Euphorb. off. 30 , "when the eyes get lachrymose." (Th. Meurer.) 

Epistaxis, Nosebleed. 

This affection is a mere symptom of the most different condi- 
tions of the organism. We observe it in consequence of conges- 
tive as well as in consequence of anaemic and chlorotic conditions. 
It may sometimes bring relief to headache and congestive states; 
and it may be an unfavorable sign in adynamic and contagious 
diseases, as small-pox and measles, when they assume a typhoid 
character. In diseases of the heart, lungs and spleen, it is never 
a good sign. In old age it is a sign of threatening apoplexy. 

Its most frequent Exciting Causes are, mechanical injuries; a 
fall or blow upon the nose; straining when coughing; and sup- 
pression or irregularity in menstrual discharges, or a suppression 
of an habitual hemorrhoidal flow. 

The blood itself varies greatly in character. It may be bright 
red or dark — almost black ; it may easily coagulate, and it may be 
quite thin and never coagulate. 

Generally, one nostril only bleeds; seldom both. The blood 
discharges either through the nostrils in front, or backwards, 
through the posterior nares, into the fauces, thence into the 
stomach or the larynx. This last phenomenon requires a little 



EPISTAXIS. 233 

attention, so as not to confound it with vomiting of blood, or 
bloody expectoration from the lungs. 

THERAPEUTIC HINTS.— In general, bright blood, Aeon., Arnica, 
Bellad., Bryon., Dulcam., Hyosc, Millefol., Rhus tox., Sabad. 

Dark blood, Crocus, Nux vom. 

Clotted blood, Chamom., Mercur., Rhus tox., Platin. 

Aeon., in arterial congestive bleeding; palpitation of the heart; 
children. 

Agar., in old people with relaxed state of the circulatory system. 

Amm. carb., in the morning, when washing. 

Argent, with tickling and crawling sensation of the nose. 

Arnica, after external injury; always worse from washing the 
face or blowing the nose. 

Arsen., after a fit of passion or vomiting; great heat and rest- 
lessness. 

Bellad,, congestion to the head ; answers questions as if fright- 
ened; pupils dilated; vertigo on stooping. Worse from motion, 
noises and bright light; sparks before the eyes; noise in the ears; 
fainting; chronic cases. 

Bryon., in the morning after rising; after being overheated; 
vicarious menstruation. 

Carb. veg., profuse and long-continuing; paleness of face; small, 
intermitting pulse; in convalescents from fever; excited by emo- 
tion, jarring; short and hot breath; numbness; tenderness in 
region of liver; jaundice. Also daily at 9 o'clock a.m. 

China, anaemic state; singing, ringing in the ears; great pale- 
ness of face and fainting. 

Conium, suppressed menstruation by taking cold; frequent ebul- 
litions of blood; jerking sensation about the heart. 

Crocus, black, viscid blood, with cold sweat on forehead; yel- 
lowish face; fainting. 

Eriger., congestion of the head ; febrile action ; red face. 

Ferrnm, in anaemic children with frequent changing of color in 
the face. Haemorrhophilia, 

Hammam., in combination with haemoptysis. 

Indigo, with dry cough. 

Kali carb., when washing the face, every morning at 9 o'clock. 

Melilot. is said to stop nosebleed immediately. 

Merc, sol., blood coagulates in the nose, and hangs down like 
icicles. 



234 nose. 

Moschus, with all the signs of depletion; spasmodic jerking of 
the muscles. 

Nux vom., congestion to the head ; pain in forehead ; constipa- 
tion; suppressed hemorrhoidal flow. 

Pulsat, vicarious menstruation; catarrhal affections; anaemic 
children. 

Rhus tox., at night; during stool; from bending forward, and 
any bodily exertion. 

Secale, anaemic state, either from exhaustive diseases or arti- 
ficial depletion; the blood is thin and does not coagulate. Aged 
persons. 

Thlaspi bursa pastoris is recommended by Bonninghausen as one 
of the most efficient remedies, but without special indications. 

Trill, pend., passive haemorrhage. 

Ver. alb., deadly paleness of face, getting red when rising; cold- 
ness of body ; slow, intermitting pulse. 

Sometimes nosebleed may be immediately stopped by com- 
pressing the facial artery, on the side of bleeding, against the 
superior maxilla near the angle of the nose. 

Polypi in the Nose 

Are mostly of the mucous variety. They have been cured by 
Calc. carb., Calc. jod., Kali nitr., 3d trit., Phosphor., Pulsat., Sanguiu. 
and Teucrium. 

Inflammation of the Nose. 

It attacks the deeper layers of the mucous membrane and the 
periosteum, and is usually circumscribed. The mucous mem- 
brane is highly inflamed, and the external skin cedematously 
swollen. The nose is very painful and at times when the inflam- 
mation extends higher up, brain symptoms appear with more or 
less fever. It may be caused by external injuries, may be asso- 
ciated with catarrh or blenorrhcea, or appear without any de- 
monstrable cause. 

THERAPEUTIC HINTS.— It is usually quickly relieved by Bellad.; 
Hepar or Silic. may in some cases be required. 



FACE. 



The face of a patient tells a long story, and it will be well for 
the student to closely observe its features, expression, color and 
temperature. The experienced physician reads out of it not only 
the degree of severity of an attack, but often also its whole gen- 
eral nature. But that must be learned by practice. There are 
shades so fine that they could not be well described, but which 
nevertheless stamp upon the whole a peculiar character. 

1. The aspect of the face. 

a. A delicate appearance, with long-fringed eyelashes and bril- 
liant eyes, often serves to point out the tubercular diathesis. 

b. The thickened alee of the nose and upper lip of scrofula are 
most marked in childhood. 

c. The pallor of anaemia is very important; it is waxy in chlo- 
rosis and pasty in diseases of the kidneys. 

d. A puffy appearance about the eyelids along with anaemia is 
very generally an indication of albuminuria. 

e. A bloated, blotchy face generally indicates irregular habits of 
living. 

/. The features undergo remarkable changes in erysipelas, par- 
otitis, facial paralysis, etc. 

g. A sunken face indicates exhaustion, either from too great ex- 
ertion, or loss of sleep, want of nourishment, or profuse diarrhoea, 
or disturbed digestion. If it sets in suddenly during pregnancy, 
it is a premonitory sign of abortus. If you find it in the incipi- 
ency of a disease, without previous weakening causes, it denotes 
a severe illness. If it sets in suddenly, during a disease, without 
chill or spasm, by which it might be caused, it is a sign of ex- 
treme exhaustion, collapse, or metastasis, mortification, or apo- 
plexia nervosa. 

h. Tlie hippocratic face is characterized in the following way: 



236 FACE. 

The skin upon the forehead is tense, dry, or covered with cold 
perspiration ; the temporal regions are sunken in ; the eyelids 
are pale, and hang down ; eyes are dull, without lustre, turned 
upwards, and sunken ; the alee nasi are pinched together, and 
the nose is very pointed; the malar bones stick out, and the 
cheeks are sunken in and wrinkled ; the ears appear to be drawn 
in, and are cold ; the lips are pale, livid ; the lower jaw sinks 
down, and the mouth is open. It is always a sign of extreme 
prostration of vital power, and is found in cholera, in mortifica- 
tion, and during death struggle. 

i. A wrinkled face is natural to old age, but in children it is a 
sign of imperfect nutrition, and is found in consequence of ex- 
hausting diarrhoea and atrophy. In boys and half-grown lads a 
wrinkled face, without loss of appetite or sleep, is a sign of onan- 
ism, or other bad habits. Such a young, old, and wrinkled face 
is a pitiful sight. 

The linea ophthalmia zygomatica is a line or fold, commencing at 
the inner canthus of the eye, running towards the zygoma where it ends. 
It shows momentarily, when children cry, but becomes more per- 
manent in children with affections of the brain. Its appearance 
in simple catarrh is said to indicate the setting in of whooping- 
cough. 

The linea nasalis is a line or fold, which commences at the upper 
part of the alas of the nose, and runs towards the orbicularis oris (the 
sphyncter of the mouth), forming a more or less perfect half-circle. 
This line, if found in children, denotes abdominal diseases, espe- 
cially inflammation of the bowels, also rachitis, scrofula and 
atrophy. In grown persons it is said to have been observed as a 
concomitant symptom of albuminuria, ulcer and cancer of the 
stomach, and degeneration of the liver. 

The linea labialis is a line or fold, which commences at the cor- 
ner of the mouth and runs down towards the side of the chin, where it 
ends, and whereby the chin appears to be elongated. This line is 
said to be a characteristic sign in children of inflammatory dis- 
eases of the larynx and lungs. Very marked it has been found 
in grown persons who suffered with ulceration of the larynx and 
bronchial affections, attended with difficulty in breathing and 
much mucous discharge. 

k. The risus sardonicus, a spasmodic distortion of the face, which 
resembles a kind of laughing, is found in irritation and inflam- 
mation of the brain, in inflammation of the pericardium and 



EXPRESSION OF THE FACE. 237 

diaphragm, in irritation of the intestinal canal, in abnormal 
conditions of the menses, even after mental excitement, fright 
and depression of spirits. 

2. The expression of the face is, in health, the reflex of the mind ; 
and in disease it has a distinct reference to the nervous system. 

In general, 1 may say: 

a. A rigid, staring, stupid, troubled, but sometimes also a smiling 
countenance, is found in affections of the brain, and in typhoid 
conditions. 

b. An anxious, sad, and restless expression is found in lung and 
heart diseases. 

c. A morose, long-faced, apathetic expression is found in abdomi- 
nal disorders. 

3. The color of the face. 

a. Redness, if habitual, denotes a tendency to gout and haemor- 
rhoids ; and is a sign of indulgence in good-living and alcoholic 
drinks. 

Flying, often-changing redness is seen in children during denti- 
tion, in women before menstruation, or after conception, and is 
also found in inflammation of the lungs. 

Bright, vivid redness is found in nervous diseases, hysteria and 
tendency to haemorrhages. 

Dark, purplish redness is found in congestive, apoplectic and 
suffocative conditions. 

Redness, coming and going in spots, I have often found in brain 
diseases of little children, and also in pneumonia. 

One-sided redness, with paleness and coldness of the other side, 
in encephalitis, is, according to Schonlein, a sign of the formation 
of pus in that half of the brain which corresponds to the red side 
of the face. It is found also in diseases of the lungs, heart and 
abdomen, and in children during dentition. 

The circumscribed hectic flush is characteristic of phthisis. 

Redness of the cheeks, with a white ring around the alse of the nose 
and the mouth, are frequently met with in different fevers, espe- 
cially scarlatina, and is a sign of pretty severe illness. 

b. Paleness. 

Sudden paleness, especially around the mouth, is found in children 
with colicky spasms in the abdomen. 

Great paleness, alternating with flushes of redness, is found in in- 
flammation of the lungs and brain ; also during dentition. 

A pale, peculiar white and wrinkled face is found in children with 
chronic hydrocephalus. 



238 FACE. 

A sudden paleness, after an inconsiderable limping, in children, 
combined with great lassitude, is a sign of a lingering hip-disease. 

In women, paleness is a sign of profuse or suppressed menstrua- 
tion or chlorosis. 

Sudden paleness during pregnancy prognosticates threatening 
metrorrhagia, or abortion, or the dying of the foetus. 

Sudden paleness about the nose is in scarlet fever a bad sign ; it 
denotes a metastasis to the brain; during the pealing-off period 
it is a forerunner to dropsy. 

Sudden paleness after a fall indicates concussion of the brain. 

Pale lips are characteristic of chlorosis. 

c. Blue color of the face 

Is found in organic diseases of the heart, especially in dilata- 
tion of the ventricles and disorganizations of the valves, whereby 
the oxygenation of the blood is interfered with. In the highest 
degree it exists in cyanosis, a state in which, consequent upon 
structural faults in the heart, the venous and arterial blood be- 
comes mixed. In new-born children, therefore, if it is lasting, it 
is a sign of such malformation ; if it, however, soon passes off, it 
may have been caused by hard labor-pains, face-presentation, 
or by the navel string being wound around the neck of the 
child. 

We meet it likewise in consecjuence of strangulation or suf- 
focation. 

d. Livid, grayish, lead-colored face denotes deep-seated organic 
diseases, scirrhus, gangrene. 

e. Yellowish color of the face is found mostly in diseases of the 
liver. 

The yellowness of jaundice varies from a pale orange to a 
deep-green yellow. The yellowish color of infants does not 
always denote jaundice ; it is very often merely a discoloration 
by hsematin, which remains in the skin until absorbed, and is 
analogous to the effects of a bruise; there is no yellowish ness of 
the white of the e} r es attending it. 

There is a certain yellowness of a malignant aspect, which is 
distinguished from jaundice by the pearly lustre of the eyes. 
It is associated with a cancerous diathesis. 

/. Broun spots in women are mostly signs of pregnancy, or 
irregularity in menstruation ; they are also said to be found in 
liver complaints. 

Irregular brownish spots a little raised above the skin and 



CRUSTA LACTEA. 239 

covered with small pustules, which sometimes discharge a bloody 
fluid, are in children a sign of congenital syphilis. 

Fat, short, and broad persons, with dark-brown or black hair, 
dark eyes, yellow-brownish, dark color of the skin, are mostly 
affected on the right side with liver complaints and so on. 

g. Telangiectasias on the face, especially on the upper parts of 
the cheeks and on the lower eyelids, are almost always connected 
with some obstruction or stasis; often in the chest, but more 
frequently in the abdomen, and a diminution of chlorides in the 
urine. 

Telangiectasias, if ever so small, on the right side of the face, 
denote an obstruction in one of the organs on the right side ; and 
if on the left, a stasis in one of the organs on the left side. 

Bright red telangiectasias denote an arterial, whilst purplish- 
looking indicate a venous obstruction, either in the chest or ab- 
domen of the corresponding side. 

Small varices on the left side of the nose, or lips, or glans penis, 
indicate a venous obstruction in the heart or kidney. 

So also are ringworms almost always indicative of some kidney 
affections. 

4. The temperature of the face. 

a. Heat of the face is found in congestion of the head, in 
fevers, in inflammatory conditions, in coryza, and in other 
complaints. 

b. Coldness of the face we find in chills, in spasms, exhaustion, 
in sickness of the stomach, in syncope. 

A deadly coldness in cholera ; also in violent hysterical par- 
oxysms. 

In inflammation of the lungs, coldness of the face denotes the 
commencement of suppuration. 

Sudden coldness of the face in scarlet fever portends death. 



Erysipelas of the Face. 

Compare Erysipelas of the Scalp. All which is said there is 
equally applicable here. 



Crusta Lactea, Milk Crust. 

This is a disease of nursing infants. The eruption usually 
commences as a patch of slightly raised pimples. The patch 



240 FACE. 

itches, increases in size, and becomes more inflamed in conse- 
quence of being constantly rubbed ; the cuticle is raised in more 
or less defined vesicles, which are usually broken by friction ; 
the surface becomes excoriated, somewhat swollen, pouring out 
an ichorous secretion. 

With the increase of irritation, the patch spreads. In case the 
eruption commences in several patches, they are liable to run 
into one. Thus the disease increases ; the secretion, from being 
a transparent and colorless ichor, becomes opaque, milky, then 
yellowish, and at last purulent, while small pustules are devel- 
oped on the red and tumefied skin around the patch. For this 
reason it has been called impetigo. The forming crusts now 
grow thicker, and have the appearance of dried honey. Xot un- 
frequently, as a consequence of pressure or friction, blood is 
mingled with the discharges, and the crusts become colored of 
various hues, from a lightish-brown to positive black. 

Although commencing on and being confined most frequently 
to the forehead and cheeks of the child, this obstinate disease 
may attack the whole body, being a source of great suffering to 
the child and annoyance to the mother. 

Should the eruption continue even after the milk teeth are all 
cut, no new light of prophecy need beam upon the little patient, 
according to Wilson: "When puberty arrives, then certainly the 
disease will go." For, although there are cases of pretty tolerable 
stubbornness, yet I have not seen a case which did not yield to a 
judicious homoeopathic treatment in a reasonable space of time. 

THERAPEUTIC HINTS.— Arsen., pimples and vesicles; acrid dis- 
charge; itching; burning; worse at night, in cold air; better 
from external warmth. 

Bellad., teething, jerking in sleep; want to sleep yet inability to 
go to sleep. 

Calc. carb., children fair and plump ; teething; scrofulous habit ; 
worse about new moon; burning after washing; perspiration 
after eating or drinking. 

Cicuta, thick, yellowish scurf on the chin and upper lip, with 
oozing ; scurf on nose. 

Crot. tigl., itching, followed by burning; vesicles run together, 
ooze and form thick, gray-brown crusts. 

Lycop., thick crusts, underneath cracked surface; skin dry; 
excoriated places; worse at night and in warmth. 



COMEDO, ACNE PUNCTATA AND ROSACEA. 241 

Merc, sol., tendency to inflammation of the lymphatic glands; 
salivation; scorbutic gums. 

Rhus tox., acrid, inflamed look; swollen glands on neck and 
throat; stiffness of the neck. 

Sulphur, excoriations, pimples, vesicles; violent itching, worse 
at night; bleeding from scratching; diarrhoea in the morning. 

Compare Eczema Capitis. 

Comedo, Acne Punctata and Rosacea. 

"Comedo is a distended, sebaceous follicle, whose contents, pro- 
jecting above the surface of the skin, becomes black from dirt, 
and when pressed out assumes the shape of a worm. When an 
irritative process is set up around a hair follicle by the retention 
of the secretion, and assumes a true inflammatory character, we 
have Acne punctata." 

"Acne rosacea is a chronic inflammation of the face, made up of 
acne spots, periglandular inflammation, erythema, and new 
growth of connective tissue, growing independently of the 
glands." (Lilienthal, p. 126 and 127). 

THERAPEUTIC HINTS.— Comedo and Acne punctata I have seen 
disappear after Bellad. or Pulsat. Compare also Arsen., Carb. 
veg., Hepar, Kali brom., Kali hydr., Lachnanth., Silic, Sulphur. 
If in connection with sexual excesses: Calc. carb., Phosph. ac, or 
Sulphur. 

Acne rosacea is much more difficult to manage. 

Alum., when the redness is livid and the veins varicose. 

Arsen., when there is great burning. 

Calc. carb., when there are menstrual disorders and congestion 
to the head. 

Carb. veg., varicose veins on nose. 

Laches., bluish redness. 

Petrol., more at the commencement, when the vessels are not 
yet injected. 

Sulphur, great itchiness and bluish color of the face. 

Besides, compare: Ant. crud., Capsic, Carb. an., Canthar., 
Caustic, Conium, Dulcam., Ledum, Mezer., Natr. mur., Nitr. ac, 
Nux vom., Rhus tox., Ruta, Sepia. 



242 



Lupus. 



Fox, Volkman, and Vircbow consider lupus as a neoplasma, 
consisting of cell-proliferation. This large accumulation of pro- 
liferating cells, pressing away and destroying the layers of the 
cutis, and often also the deeper-lying tissues, is characteristic 
of lupus. We meet it in different stages: 1., there are only 
brownish-red spots — Lupus maculosus; 2., there are papules or 
nodules elevated above the skin, also of brownish-red color and 
in size from that of a pea to a hazel-nut — Lupus tuberculosus ; 3., 
there is infiltration; the skin appears of a similar color and is 
covered with lamellae of the epidermis — Lupus exfoliaticus ; 4., 
there are atonic ulcers, which result from the softening of the in- 
filtrations — Lupus exulcerans; 5., there are new formations rising 
above the skin which frequently involve large portions — Lupus 
hypertrophicus; and 6., there are large ulcers, extending peripheri- 
cally — Lupus serpigiuosus. The first four stages are also known 
under the name of Lupus nonexedens, and the latter two Lupus 
exedens. The favorite seat of lupus are the nose and cheeks; from 
lupus exedens great disfiguration of the face may result. 

All authors agree that lupus has nothing to do with syphilis, 
either acquired or congenital. (Lilienthal, Skin Diseases.) 

THERAPEUTIC HINTS.— Aur. mur., when starting from the mu- 
cous membrane of nose and spreading to the cartilages, bones 
and skin. 

Graphii, lupus of nose, with deep ulceration. 

Lycop., superficial ulceration in pale, sallow patients. 

Besides, compare : Arsen., Baryta carb., Carb. an. and veg., Caustic. 
Cicuta, Hydrocotele Asiatica, Kali bichr., Phosphor., Silic., Staphis., 
Sulphur, Thuja. 

Ulcus Rodens and Epithelioma. 

The Rodent ulcer has hard sinuous edges, is of several or perhaps 
of many years duration, almost painless, and occurs in middle- 
aged or elderly persons of fair health and without enlarged 
glands. It attacks by preference the eyelids and the adjacent 
portions of the ckeek, the nose, or the cheeks. It is as rare on 
the lower as epithelioma is on the upper lip. 

Epithelioma is the common form of so-called cancer of the lip or 



ULCERS RODENS AND EPITHELIOMA. 243 

tongue (also of vulva, clitoris, penis and rectum). It is essen- 
tially an infiltrating disease, beginning, as a- rule, as a little wart 
or tubercle, and then gradually spreading, it may crack, fissure 
and ulcerate, and when at this stage, we easily recognize its ma- 
lignant character by the infitration with the cancerous material, 
and the integument then presents the well-known indurated and 
everted edges. The base of the ulcer is dirty or greyish, more or 
less papillated; it may be reddish and discharge a thin fluid, or 
be disposed to scab over. (Lilienthal's Skin Diseases). 

THERAPEUTIC HINTS. — For Rodent ulcer compare: Arsen., 
Bellad., Cicuta, Hepar, Hydrocotyle, Hydrast., Mercur., Nitr. ac, 
Silic, Staphis., Sulphur, Uran. 

For Epithelioma of lip compare: Acet. ac, Arg. nitr., Arsen., 
Ars. jod., Aurum, Bellad., Carb. an., Chelid., Clemat., Conium, 
Hydrast., Kreosot., Laches., Pulsat., Silic, Sulphur, Thuja. 



MOUTH 



1. Its external parts. 

The lips we have had to notice on several occasions, as parts of 
the face. 

Their paleness denotes poverty of blood ; a transient paleness, 
however, is found in chills, spasms, fainting fits and frights. 

Their redness is a healthy condition ; but an increased, deeper 
or brighter redness is found in feverish conditions. A higher red- 
ness of the lower lip, without apparent fever, indicates Sulphur. 

Bluish lips are seen in all such conditions, where a free circu- 
lation of blood is interfered with. 

Dry lips are found in all acute, feverish or inflammatory con- 
ditions. 

Brownish or even blackish crusts form in typhoid states. 

Fever-blisters, hydroa, are found on the lips very often in inter- 
mittent fevers and pneumonia, scarcely ever, however, in typhus; 
and lastly, the cancer of the lip, a malignant growth, appears 
mostly at the prolabium, rarely at the adjoining integument of 
the lip. 

The mouth is kept open in stoppage of the nose, difficulty of 
breathing, great interior heat, hardness of hearing. In fevers it 
is a sign of great exhaustion — the lower jaw falling down, 
especially during slumber. This symptom very frequently in- 
dicates Lycop. 

The mouth is sjjasmodically closed in lock-jaw and other spas- 
modic affections. 

2. The interior cavity of the mouth. — AVe shall examine it under 
the following heads: Gums, teeth, tongue, salivary glands and 
their ducts, tonsils, uvula, soft palate, fauces and mucous mem- 
brane of the mouth and fauces. 



PARULIS — EPULIS. 245 



The Gums 



Present different aspects. They are pale in ansemia, from the 
abuse of iron and mercury, and in spasmodic conditions; blue in 
cyanosis and scurvy; brown and blackish, coated with tough 
mucus, in typhoid conditions ; a bluislt, grayish, slate-colored stripe 
or line on the gums is a sign of lead-poisoning ; a purple line is 
found in old age, and a pink line, especially on the gums of the 
lower jaw by paleness of the remaining gums, is often met with 
in phthisical persons. 

Swelling of the gums is either of a congestive and inflammatory 
nature — in toothache, parulis — or of an cedematous and spongy 
nature (in scurvy, mercurial affections, noma, stomatitis.) In 
such conditions the gums generally bleed easily when being 
cleansed, or only slightly touched. 

Bleeding gums are said to have been observed also from sup- 
pressed menstrual or hemorrhoidal bleedings — vicarious bleed- 
ing. 

Ulcerated gums may originate from diseased states of the teeth, 
from general maladies or from constitutional maladies, such as 
scurvy, syphilis, mercurial poisoning, noma, stomatitis. 

The special diseases of the gums are : 

Parulis, Gumboil, Inflammatory Swelling of the Gums. 

This generally takes its origin in a diseased tooth, but may 
appear without any known cause. Its seat is almost always on 
the gums, covering the external side of the alveolar processes, 
and may reach to such a height as to swell up the cheek and 
corresponding side of the face, making chewing and talking a 
very difficult operation. It almost always ends in the formation 
of an abscess, which breaks and discharges. 

THERAPEUTIC HINTS.— Hepar, Mercur., Silicea. 

Epulis, a kind of Fungoid Growth on the Gums. 

This originates either in the gums, periosteum, or on the maxil- 
lary bone. When it begins in the gums or periosteum, there is a 
reddish or bluish-red, hard and painless swelling of a roundish 
or oval shape, growing out of the alveolar process or between the 
teeth. It is somewhat movable if it rests upon a broad pedicle ; 



246 gums. 

generally, however, it has none, and shows no distinct boun- 
daries. In its further progress it assumes the form of an irreg- 
ular, fleshy lump, which, growing larger, overlaps one or more 
teeth ; the adjoining teeth are pressed out of their position, and 
grow crooked or fall out. The swelling soon bursts through the 
mucous membrane, by which it has been covered, and presents 
a tuberous, grayish-red mass, which is either an entire mass or 
is split into different, irregular lobes by deep crevices. It bleeds 
easily, and, by sloughing, pieces of it fall off, forming cavities, 
which secrete a most offensive ichorous discharge. 

When it starts from the maxillary bone, we observe at first a 
swelling of the bone, then the teeth fall out, and at last the mor- 
bid growth bursts forth. 

In some cases it has its seat in the antrum Highmorianum. 

THERAPEUTIC HINTS.— Calc. ca.rb., Cbamom., Xatr. mur. 
Thuja. 

Fistula of the Teeth. 

In consequence of inflammation of the periosteum lining the 
root of the teeth, and its consequent suppuration, or caries of the 
root and alveolar processes, a channel is gradually formed, 
which opens either on the inside of the mouth or outside of the 
face, where it discharges a morbid secretion, and forms hard, cal- 
lous edges on its outlet. This is called a Fistula dentalis. 

THERAPEUTIC HINTS. — Compare Askalabotes, Calc. carb., 
Caustic, Ratan., Silic, Sulphur. 

The Teeth. 

The ossification of the dental sacs of the twenty milk-teeth takes 
place in the fifth month of pregnancy. Their eruption, as a gen- 
eral rule, not however without many exceptions, takes place in 
the following groups : 

1. The lower two incisors between the fourth and seventh 
months, followed by a pause of from three to nine weeks : 

"2. The four upper incisors — at first the two central, then the 
two lateral — between the eighth and tenth months, followed by 
a pause of from six to twelve weeks ; 

3. The first two molars of the upper, then the lower incisor?. 
and lastly the molars of the lower jaw, between the twelfth and 



TEETH. 247 

fifteenth months, followed hy a pause until the eighteenth 
month ; 

4. The canine teeth (eyes and stomach teeth) between the 
eighteenth and twenty-fourth months, followed by a pause of 
from two to three months ; 

5. The four second molars between the twentieth and thirtieth 
months. 



k-, ^iS^JrJj- 3 




This period of first dentition is often attended with serious 
ailments of the child. We find it complicated frequently with 
ulcers on tip of tongue or other portions of the mouth ; with ab- 
normally increased secretion of the fluids of the mouth, slobber- 
ing; with conjunctival blenorrhcea, especially during the erup- 
tion of the eye-teeth and upper molars ; with catarrhal affections 
of the alimentary canal — diarrhoea and vomiting, and of the 
respiratory organs — catarrh on the chest ; with cutaneous erup- 
tions, such as : urticaria, pomphi, lichen, prurigo, eczema, and 
impetigo (crusta lactea) ; with disorders of the nervous system — 
spasms and eclampsia; and with fever, a general elevation of 
the body temperature. How is this ? Can such a comparatively 
small irritation, as of necessity must be combined with the teeth 
piercing through the gums, cause all such mischief? Or is it not 
rather one of those common mistakes, where a thing is supposed 
to be the cause of another thing, because it is found simultane- 
ously with the same? May not it and the other have both a still 
deeper, yet common cause? And this cause is the development of 
the brain, which at that time is greater and more rapid than at any 
other period of life, lasting to the seventh year of life. The soft 
tissue of the brain grows denser, and the distinction between its 
cortical and medullary, or gray and white substance, becomes more 
marked, whilst the yellowish substance, which had formed a line 
of demarcation between them, gradually fades away. The brain 
of infants is, compared with the remaining body, very volumi- 
nous; being in the proportion of 1 : 8, whilst in adults it is in 
the proportion of 1 : 40 or 50. And still it grows on rapidly up 



248 TEETH. 

to the seventh 3 r ear, so that the brain of an infant, which weighs 
at its birth, say three-quarters of a pound, weighs in its second 
year nearly one pound and a half, until up to the seventh year 
it attains a weight of two pounds and a half and more. (Burdach.) 
It is clear, that such great and marked changes in the central 
organ may naturally be attended by a liability to disturbances 
in its own sphere and other peripheric organs, and this is the 
reason why the period of dentition, which is in itself only the re- 
sult of this interior development of the brain, is attended by so 
manifold and serious disturbances. I hope this will be sufficient 
to prove the absurdity of the practice of lancing the gums during 
infancy. 

The teeth become loose from mercurial poisoning, in scurvy 
and syphilitic affections. 

The decay of the teeth is ascribed to microscopic parasites, and 
to a want of silicea in the system. 

A decay near the gums of the teeth is a sign of sycosis. 

Odontalgia, Toothache. 

Toothache has many causes : decay of the teeth and exposure 
of the nerve ; various affections of different organs of the body ; 
taking cold, etc. The best treatise on this painful affection, the 
curing of which has won many a friend to Homoeopathy, is that 
of Dr. Hering in his Domestic Physician. With the kind per- 
mission of its author, I shall insert it here with some additions : 

Most in the Front-teeth. — Bellad., Caustic, Carb. veg., Chamom., 
China, Coffea, Ignat., Mercur., Natr. mur., Nux mosch., 
Nux vom., Phosphor., Phosph. ac, Rhus, Silic, Staphis., 
Sulphur. 

Most in the Eye and Stomach-teeth. — Aeon., Calcar., Hyosc, Rhus, 
Staphis. 

Most in the Molars or Back-teeth. — Arnica, Bellad., Bryon., Calcar., 
Carb. veg., Caustic, Chamom., China, Coffea, Hyosc, 
Ignat., Mercur., Nux mosch., Nux vom., Phosphor., 
Phosph. ac, Pulsat., Rhus, Silic, Staphis., Sulphur. 

Most in the Upper-teeth. — Bellad., Bryon., Calcar., Carb. veg., China, 
Natr. mur., Phosphor. 

Most in the Lower-teeth. — Arnica, Bellad., Bryon., Carb. veg., Caustic, 
Chamom., China, Hyosc, Ignat., Mercur., Nux vom., 
Phosphor., Pulsat., Bhus, Silic, Staphis. 



ODONTALGIA, TOOTHACHE. 249 

One-sided. — Aeon., Bellad., Chamom., Mercur., Nux vom., Pulsat. 
On the Left side. — Aeon., Ap. vir., Arnica, Carb. veg., Caustic, 

Chamom., China, Hyosc, Mercur., Nux mosch., Phosphor., 

Rhus, Silic, Sulphur. 
On the Right side. — Bellad., Bryon., Calcar., CofFea, Laches., Natr. 

mur., Nux vom., Phosph. ac, Staphis. 
A whole Row of Teeth. — Chamom., Mercur., Rhus, Staphis. 
In Hollow Teeth. — Ant. crud., Bellad., Bryon., Calcar., Carb. veg., 

Caustic, Chamom., China, Coffea, Hepar, Hyosc, Laches., 

Mercur., Nux mosch., Nux vom., Phosphor., Phosph. ac, 

Pulsat., Rhus, Silic, Staphis., Sulphur. 
In the Gums. — Ant. crud., Arnica, Bellad., Bryon., Calcar., Carb. 

veg., Chamom., China, Hepar, Hyosc, Laches., Mercur., 

Natr. m,ur., Nux mosch., Nux vom., Phosphor., Phosph. 

ac, Pulsat., Rhus, Silic, Staphis., Sulphur. 

Upper. — Bellad., Calcar., Natr. mur. 

Lower. — Caustic, Phosphor., Staphis., Sulphur. 

Interior of. — Arnica, Natr. mur., Phosph. ac, Pulsat., Rhus, 

Staphis. 
Swollen. — Aeon., Bellad., Calcar., Chamom., Carb. veg., 

Caustic, China, Hepar, Laches., Nux vom., Natr. mur., 

Phosphor., Pulsat., Rhus, Sulphur. 
Painful. — Ap. vir., Arsen., Calcar., Carb. veg., Caustic, 

Laches., Mercur., Nux mosch., Nux vom., Phosphor., 

Staphis., Sulphur. 
Bleeding. — Bellad., Calcar., Carb. veg., Caustic, Laches., 

Mercur., Nux mosch., Nux vom., Phosphor., Staphis., 

Sulphur. 
Ulcerated. — Bellad., Calcar., Carb. veg., Caustic, Hepar, 

Laches., Mercur., Natr. mur., Nux vom., Phosphor., 

Staphis., Silic. 
Pressing. — Aeon., Arnica, Bryon., Carb. veg., Caustic, China, 

Hyosc, Ignat., Natr. mur., Nux mosch., Nux vom., Phos- 
phor., Rhus, Silic, Staphis., Sulphur. 

Inwards. — Rhus, Staphis. 

Outward. — Phosphor. 

Asunder. — Phosph. ac. 

As if from Congestion of the Blood, as if the teeth were too 

close. — Aeon., Arnica, Bellad., Chamom., Calcar., China, 

Coffea, Hepar, Hyosc, Nux vom., Pulsat. 
As if pulled out or wrenched. — Arnica, Caustic, Nux mosch., Nux 

vom., Phosph. ac, Rhus. 



250 TEETH. 

Too Long. — Arnica, Arsen., Bellad., Bryan., Calcar., Carb. veg., 
Caustic, Chamom., Laches., Hyosc, Natr. mur., Nux 
vom., Rhus, Silic, Sulphur. 

Loose. — Arnica, Arsen., Bryon., Carb. veg., Caustic, Chamom., 
China, Hepar, Hyosc, Ignat., Mercur., Natr. mur., Nux 
mosch., Nux vom., Phosphor., Pulsat., Rhus, Staphis., 
Sulphur. 

As if too Loose. — Arsen., Bryon., Hyosc, Mercur., Rhus. 

Blunt. — Aeon., China, Dulcam., Ignat., Laches., Natr. mur.. Mer- 
cur., Nux mosch., Phosphor., Phosph. ac, Pulsat., Silic, 
Staphis., Sulphur. 

Sore, Bruised. — Arnica, Arsen., Bellad., Bryon., Calcar., Carb. veg., 
Caustic, Ignat., Natr. mur., Nux vom., Phosphor., Pul- 
sat., Rhus. 

Burning. — Chamom., Mercur., Natr. mur., Nux vom., Phosphor., 
Pulsat., Rhus, Silic, Sulphur. 

Gnawing, Scraping. — Chamom., Nux vom., Rhus, Staphis. 

Digging. — Ant. crud., Bryon., Calcar., China, Ignat. 

Boring. — Bellad., Calcar., Laches., Mercur., Natr. mur., Nux vom.. 
Phosphor., Phosph. ac, Silic., Sulphur. 

Jerking, Twitching. — Ap. vir., Ant. crud., Arsen., Bryon., Bellad., 
Calcar., Caustic, Cepa, Chamom., Coffea, Hepar, Hyosc, 
Laches., Mercur., Nux com., Pulsat.. Rhus, Sulphur. 

Drawing, Tearing. — Ant. crud., Bellad., Bryon., Carb. veg.. Calcar.. 
Cepa, Chamom., China, Glonoin., Hyosc, Laches., Mer- 
cur., Nux vom., Phosph. ac, Rhus, Staphis. 

Cutting, Piercing. — Aeon., Ant. crud., Bellad., Bryon., Calcar., Caus- 
tic, Chamom., China, Laches., Mercur.. Nux vom., Nux 
mosch., Phosphor., Phosph. ac, Pulsat., Rhus, Silic, 
Staphis. 

Beating, Pulsating. — Aeon., Arnica, Arsen., Bellad., Calcar., Caus- 
tic, Chamom., China, Coffea, Glonoin., Hyosc, Laches.. 
Mercur., Natr. mur., Phosphor., Pulsat., Rhus, Staphis.; 
Sulphur. 

Intermittent. — Bellad., Bryon., Chamom., Coffea, Calcar., China. 
Mercur., Nux vom., Pulsat., Rhus, Silic, Staphis., 
Sulphur. 

Constant, day and night. — Bellad., Calcar., Caustic, Natr. mur., 
Silic, Sulphur. 

During the day only, better in the night. — Mercur. 

, none in the night. — Bellad., Calcar., Mercur., 

Nux vom. 



ODONTALGIA, TOOTHACHE. 251 

During the day only, worse in bed. — Ant. crud., Mercur. 

Worse in the night. — Aeon., Ant. crud., Arsen., Bcllad., Bryon., 
Carb. veg., Chamom., China, Coffea, Hepar, Hyosc, Mer- 
cur., Natr. mur., Nux mosch., Nux vom., Phosphor., 
Phosph. ac, Pulsat., Rhus, Silic, Staphis., Sulphur. 

By night only, not during the day. — Phosphor. 

Most before midnight. — Bryon., Chamom., China, Natr. mur., Rhus, 
Sulphur. 

after . — Arsen., Bellad., Bryon., Carb. veg., Cha- 
mom., China, Mercur., Natr. mur., Pulsat., Phosphor., 
Rhus, Staphis., Sulphur. 

When awaking. — Bellad., Carb. veg., Laches., Nux vom. (See 
Sleep.) 

In the morning. — Arsen., Bellad., Bryon., Caustic, Carb. veg., China, 
Hyosc., Ignat, Natr. mur., Nux vom., Phosphor., Phosph. 
ac, Pulsat., Rhus, Staphis., Sulphur. 

At noon. — CoccuL, Rhus. 

After noon. — Calcar., Caustic, Mercur., Nux vom., Phosphor., Pul- 
sat., Sulphur. 

Towards evening. — Pulsat. 

At night. — Ant. crud., Bellad., Bryon., Calcar., Caustic, Hepar, 
Hyosc, Ignat., Mercur., Nux mosch., Nux vom., Phosphor., 
Pulsat., Rhus, Staphis., Sulphur. 

Every other day. — China, Natr. mur. 

Every seventh day. — Arsen., Phosphor., Sulphur. 

In Spring. — Aeon., Bellad., Bryon., Calcar., Carb. veg., Dulcam., 
Laches., Natr. mur., Nux vom., Pulsat., Rhus, Silic, 
Sulphur. 

In Summer. — Ant. crud., Bellad., Bryon., Calcar., Carb. veg., Cha- 
mom., Laches., Natr. mur., Nux vom., Pulsat. 

In Autumn. — Bryon., China, Mercur., Nux vom., Nux mosch., 
Rhus. 

In Winter. — Aeon., Arsen., Bellad., Bryon., Calcar., Carb. veg., 
Caustic, Chamom., Dulcam., Hepar, Hyosc, Ignat., 
Mercur., Nux mosch., Nux vom., Phosphor., Phosph. ac, 
Pulsat., Rhus, Silic, Sulphur. 

Caused by Damp night-air. — Nux mosch. 

Damp-air. — Mercur. 

Cold damp weather. — Nux mosch., Cepa, Rhus, Natr. sulph. 

Wind. — Aeon., Pulsat., Rhus, Silic. 

Draught. — Bellad., Calcar., China, Sulphur. 



252 TEETH. 

Taking cold. — Aeon., Bellad., Bryon., Calcar., Caustic, Chamom., 
China, Coffea, Dulcam., Ignat., Hyosc, Mercur., Nux com., 
Nux mosch., Phosphor., Pulsed., Rhus, Staphis., Sulphur. 

, when overheated. — Glonoin., Rhus. 

, by getting wet. — Bellad., Calcar., Caustic, Hepar, Laches., 

Nux mosch., Phosphor., Pulsat., Rhus, Sulphur. 

Suppressed Perspiration. — Chamom., Rhus. 

Getting worse from Cold Air. — Bellad., Calcar., Hyosc, Mercur., Nux 
mosch., Nux vom., Sabad., Silic, Staphis., Sulphur. 

in the mouth. — Aeon., Bellad., Bryon., Calcar., Caustic, 

Hyosc, Mercur., Nux mosch., Nux vom., Phosphor., Pul- 
sat., Silic, Staphis., Sulphur. 

Opening of the mouth. — Bryon., Chamom., Caustic, Hepar, 

Nux vom., Phosphor., Pulsat. 

Breathing. — Pulsat. 

Drawing Air into the Mouth.— Ant. crud., Bellad., Bryon., 

Calcar., Caustic, Hepar, Mercur., Natr. mur., Nux 
mosch., Phosphor., Silic, Staphis., Sulphur. 

Cold washing. — Ant. crud., Bryon., Calcar., Chamom., Mer- 
cur., Nux mosch., Nux vom., Pulsat., Rhus, Silic, Staphis., 
Sulphur. 

Eating cold things. — Bryon., Calcar., Chamom., Nux vom., 

Pulsat., Rhus, Sabad., Staphis., Sulphur. 

Drinking cold things. — Bryon., Calcar., Chamom-., Caustic, 

Hepar, Laches., Mercur., Natr. mur., Nux mosch., Nux 
vom., Pulsat., Sabad., Silic, Staphis., Sulphur. 

Rinsing of the Mouth with Cold Water. — Sulphur. 

Cold in general. — Arscn., Ant, crud., Calcar., Carb. veg., 

Mercur., Natr. mur., Nux mosch., Nux vom., Pulsat., 
Phosphor., Rhus, Silic, Staphis., Sulphur. 

In the Open Air. — Bellad., Calcar., Caustic, Chamom., China, Hyosc , 
Mercur., Nux mosch., Nux vom., Phosphor., Pulsat,, Rhus, 
Staphis., Sulphur. 

, Staying. — Bellad., Bryon., Chamom., Hyosc, Mercur., Nux 

vom., Phosphor., Staphis., Sulphur. 

, Walking. — Nux vom., Phosphor., Staphis. 

In a Room. — Ap. vir., Ant, crud., Chamom., Hepar, Nux vom., Pul- 
sat., Sulphur. 

after coming out of the open air. — Phosphor. 

In a warm Room. — Bryon., Cepa, Chamom., Hepar, Nux vom., Pul- 
sat., Phosphor. 



ODONTALGIA, TOOTHACHE. 253 

Warm Stove. — Arsen., Pulsat. 

External warmth. — Bryon., Chamom., Hepar, Mercur., Nux mosch., 

Nux vom., Phosphor., Phosph. ac, Pulsat., Rhus, Sta- 

phis., Sulphur. 
Something warm. — Bryon., Calcar., Carb. veg., Chamom., Coffea,- 

Laches., Mercur., Natr. mur., Nux vom., Phosph. ac, 

Pulsat., Silic, Sulphur. 
Eating warm things. — Bryon., Calcar., Chamom., Nux vom., Phos- 
phor., Pulsat., Silic. 
Something hot. — Bellad., Calcar., Phosph. ac. 
Drinking warm things. — Bryon., Chamom., Laches., Mercur., Nux 

mosch., Nux vom., Pulsat., Rhus, Silic. 
Warm Bed. — Bellad., Bryon., Chamom., Mercur., Nux vom., Phos- 
phor., Phosph. ac, Pulsat., Rhus. 
Getting warm in bed. — Chamom., Mercur., Phosph. ac, Phosphor., 

Pulsat. 
Drinking. — Chamom., Calcar., Caustic, Laches., Mercur., Pulsat., 

Rhus, Silic. 

Cold or warm. — Laches., Natr. sulph. 

Water. — Bryon., Calcar., Carb. veg., Chamom., Mercur., 

Nux vom., Pulsat., Silic, Staphis., Sulphur. 

Wine. — Aeon., Ignat. [Nux vom. after wine]. 

Malt liquors. — Nux vom., Rhus. 

Coffee. — Bellad., Carb. veg., Chamom., Coccul., Ignat., 

Mercur., Natr. sulph., Nux vom., Pulsat., Rhus. 

Tea. — China, Coffea, Ignat., Laches. 

Smoking tobacco. — Bryon., Chamom., China, Ignat., Mercur., Nux 

vom. 
Salty things. — Carb. veg. 
Eating. — Ant.' crud., Arnica, Bellad., Bryon., Calcar., Carb. veg., 

Caustic, Chamom., Coccul., Hepar, Hyosc, Laches., 

Mercur., Nux mosch., Nux vom., Phosphor., Phosph. ac, 

Pulsat., Rhus, Silic, Staphis., Sulphur. 
Only while eating. — Coccul. 
After eating. — Ant. crud., Bellad., Bryon., Calcar., Chamom., China, 

Coffea, Ignat, Laches., Mercur., Natr. mur., Nux vom., 

Rhus, Staphis., Sulphur. 
Chewing. — Arnica, Arsen., Bellad., Bryon., Carb. veg., Caustic, 

China, Coccul., Coffea, Hyosc, Ignat., Mercur., Natr. mur., 

Nux vom., Phosphor., Phosph. ac, Pulsat,, Silic, Staphis., 

Sulphur. 



254 TEETH. 

Only while chewing. — China. 

Swallowing.— Staphis. 

Biting. — Arsen., Bellad., Bryon., Calcar., Carb. veg., Caustic, 

China, Coffea, Hepar, Hyosc, Laches., Mercur., Nux 

vom., Phosphor., Phosph. ac, Pulsat., Rhus, Silic, 

Staphis., Sulphur. 

something soft. — Veratr. 

soft food. — Coccul. 

hard food. — Mercur. 

Touched by the food. — Bellad., Ignat., Nux vom., Phosphor., Staphis. 

Picking. — Pulsat. 

Cleaning. — Carb. veg., Laches., Phosph. ac. Staphis. 

Touching. — Ant. crud., Arnica, Arsen., Bellacl, Bryon., Calcar., 

Carb. veg., Caustic, China, Coffea, Hepar., Ignat., Mercur., 

Natr. mur., Nux mosch., Xux vom., Phosphor., Pulsat., 

Rhus, Staphis., Sulphur. 
with the tongue. — Carb. veg., China, Ignat., Mercur., Phos- 
phor., Rhus. 

even very softly. — Bellacl., Ignat., Nux vom., Staphis. 

Pressing on the teeth. — Caustic, China, Hyosc, Natr. mur., Staphis., 

Sulphur. 
Sucking the gums. — Bellad., Carb. veg., Nux mosch., Nux vom., 

Silic 
Rising. — Ignat., Mercur., Platin. 
Moving the body. — Arnica, Bellad., Bryon., China, Mercur., Nux 

vom., Phosphor., Staphis. 

the mouth. — Caustic, Chamom., Mercur., Nux vom. 

Talking. — Nux mosch. 

Deep breathing. — Nux vom. 

Being at rest. — Arsen., Bryon., Chamom., Pulsat., Rhus, Staphis., 

Sulphur. 
Sitting. — Ant. crud., Mercur., Pulsat, Rhus. 

too much. — Aeon. 

While lying down. — Arsen., Bellad., Bryon., Chamom,, Hyosc, Ignat., 

Mercur., Nux vom., Phosphor., Pulsat., Rhus, Staphis., 

Sulphur. 

on the painful side. — Arsen., Nux vom. 

on the painless side. — Bryon., Chamom., Ignat., Pulsat. 

in bed. — Bryon., Chamom., Nux vom., Pulsat, 

In bed. — Ant. cruel, Bellad., Bryon., Chamom., Mercur., Nux vom., 

Phosphor., Pulsat. 



ODONTALGIA, TOOTHACHE. 255 

Sleep with yawning. — Staphis. 

When going to sleep. — Ant. crud., Arsen., Mercur., Sulphur. 

While asleep. — Mercur. 

When awaking. — Bellad., Bryon., Calcar., Carb. veg., Laches., Nux 

vom., Phosphor., Silic, Sulphur. 
Mental emotions. — Aeon. 
Vexation. — Aeon., Chamom., Rhus, Staphis. 
Passion. — Nux vom. 

Mental exertions. — Bellad., Ignat, Nux vom. ' 
Reading. — Ignat., Nux vom. 
Noise. — Calcar. 

Being talked to by others. — Arsen. Bryon. 
For women. — Aeon., Ap. vir., Bellad., Calcar., Chamom., China, 

Coffea, Hyosc., Ignat., Xux mosch., Pulsat. 
Menstruation, before. — Arsen. 
during. — Calcar., Chamom., Carb. veg., Natr. mur., Laches., 

Phosphor. 

after. — Bryon., Calcar., Chamom., Phosphor. 

During pregnancy. — Ap. vir., Bellad., Bryon., Calcar., Hyosc., Mer- 
cur., Nux mosch., Nux vom., Pulsat, Rhus, Staphis. 
While nursing. — Aeon., Arsen., Bellad., Calcar., China, Dulcam., 

Mercur., Nux vom., Phosphor., Staphis., Sulphur. 
For children. — Aeon., Ant. crud., Bellad., Calcar., Chamom., Coffea, 

Ignat., Mercur., Nux mosch., Pulsat., Silic. 
For irritable, nervous persons. — Aeon., Bellad., Chamom., Coffea, 

China, Hyosc, Nux mosch. 
For persons who have taken much mercury. — Carb. veg., Bellad., 

Hepar, Laches., Staphis. 
who drink much coffee. — Bellad., Carb. veg., Chamom., 

Coccul., Mercur., Nux vom., Pulsat., Silic. 
Getting better from: — 
Cold air. — Nux vom., Pulsat. 
Wind. — Calcar. 
Uncovering. — Pulsat. 

Drawing air into the mouth. — Nux vom., Pulsat. 
Cold washing. — Bellad., Bryon., Chamom., Pulsat. 
External cold. — Bellad., Bryon., Chamom., China, Mercur., Nux 

vom., Phosphor., Pulsat., Staphis., Sulphur. 
Cold hand. — Rhus. 

Finger wet with cold water. — Chamom. 
Holding cold water in the mouth. — Bryon., Cepa, Coffea, Clemat., 

Natr. sulph. 



256 TEETH. 

Cold drinking. — Bellad., Bryon., Chamom., Mercur., Nux vom., 

Phosphor., Pulsat., Rhus, Sulphur. 
In the open air. — Ant. cruel., Bryon., Cepa, Hepar, Nux vom., 

Pulsat. 
In the room. — Nux vom., Phosphor., Sulphur. 
External warmth. — Arsen., Bellad., Calcar., Chamom., China, 

Hyosc, Laches., Mercur., Nux mosch., Nux vom., 

Pulsat., Rhus, Staphis., Sulphur. 
Wrapping up the head.— Nux vom., Phosphor., Silic. 
Eating something warm. — Arsen., Bryon., Nux mosch., Nux vom., 

Rhus, Sulphur. 

Drinking . — Nux mosch., Nux vom., Pulsat., Rhus., Sulphur. 

Getting warm in bed. — Bryon., Nux vom. 

Drinking. — Bellad. 

Smoking tobacco. — Mercur. 

When eating. — Bellad., Bryon., Chamom., Phosph. ac, Silic. 

After . — Arnica, Calcar., Chamom., Phosph. ac, Rhus, Silic. 

When chewing. — Bryon., China, Coffea. 
Biting. — Arsen., Bryon., China, Coffea. 
Picking the teeth, so that they bleed. — Bellad. 
Picking the teeth. — Phosphor, ac. 

Rubbing . — Mercur., Phosphor. 

Touching the teeth. — Bryon., Nux vom. 

Sucking the gums. — Caustic. 

Pressing upon the teeth. — Bellad.. China, Bryon., Ignat., Natr. 

mur., Pulsat., Phosphor., Rhus. 
Moving. — Pulsat., Rhus. 
When walking. — Pulsat., Rhus. 
When at rest. — Bryon., Nux vom., Staphis. 
Sitting up in bed. — Arsen., Mercur., Rhus. 
Getting up. — Phosphor., Nux vom. 
When lying down. — Bryon., Mercur., Nux vom. 

on the painful side.— Bryon., Ignat,, Pulsat. 

painless . — Nux vom. 

lying down in bed. — Mercur., Pulsat. 

In bed. — Sulphur. 
When going to sleep. — Mercur. 
After sleep. — Nux vom., Pulsat. 
The pains extend 

to the jawbones and face. — Laches., Mercur., Nux vom., 

Hyosc, Rhus, Sulphur. 



ODONTALGIA, TOOTHACHE. 257 

The pains extend 

to the cheeks. — Chamom., Caustic, Bryon., Mercur., Silic, 

Staphis., Sulphur, 
into the ears. — Arsen., Bryon., Calcar., Chamom., Hepar, 

Laches., Mercur., Staphis., Sulphur, 
into the eyes. — Caustic, Chamom., Mercur., Pulsat, Staphis., 

Sulphur, 
into the head. — Ant. crud., Arsen., Chamom., Hyosc, Mer- 
cur., Nux vom., Rhus., Staphis., Sulphur. 

With headache. — Ap. vir., Glonoin., Laches. 

rush of blood to the head. — Aeon., Calcar., China, Hyosc, 

Laches., Pulsat. 

swollen veins of the forehead and hands. — China. 

heat in the head. — Aeon., Hyosc, Pulsat., 

burning of the eyes. — Bellad. 

flushed cheeks. — Aeon., Arnica, Bellad., Chamom., Mercur., 

Nux mosch., Nux vom., Phosphor, Pulsat., Rhus tox., 
Sulphur. 

pale face. — Aeon., Arsen., Ignat., Pulsat., Staphis., Sulphur. 

swelling of the cheek. — Arnica, Arsen., Bellad., Bryon., 

Chamom., Laches., Mercur., Natr. mur., Nux vom., Pul- 
sat., Phosphor., Phosph. ac, Staphis., Sulphur. 

salivation. — Bellad., Dulcam., Mercur. 

dry mouth and thirst. — China. 

without thirst. — Pulsat. 

dry throat and thirst. — Bellad. 

— ' chilliness. — Pulsat., Rhus. 

heat. — Hyosc, Rhus. 

warm perspiration. — Hyosc. 

chilliness, heat, thirst. — Laches. 

diarrhoea. — Chamom., Coffea, Dulcam., Rhus. 

constipation. — Bryon., Mercur., Nux vom., Staphis. 

1. Arnica after the extraction of a tooth ; it will stop the bleed- 
ing and accelerate the healing of the gums. After the insertion 
of artificial teeth, it relieves the pain in the swelling ; after filing 
I out carious teeth — which is sometimes a very useful operation — 
mix a few globules of it in a teaspoonful of water, and put some 
of it on the parts which have been filed. In very intense pain, 
occurring after a tooth has been drawn, sometimes Hyosc. is 
of use. Arnica is sometimes good for throbbing toothache, with 
17 



25S TEETH. 

a sensation as if the tooth were being forced out from its socket 
by the blood ; hard swelling of the cheeks. 

2. Coffea will remove the severest pains, which drive the pa- 
tients almost frantic; they cry, tremble, and do not know what 
to do; the pain is indescribable; it is momentarily relieved by 
holding cold water in the mouth. For stinging, jerking pain, or 
intermitting aching and pain when chewing, it is to be preferred 
to all other remedies. 

3. Aeon, must be given in all those cases where the patients 
are almost frantic with pain, which is indescribable, and which 
Coffea has failed to relieve; also for throbbing pains, occasioned 
by taking cold, with determination of blood to the head; burning 
in the face; it is particularly suitable for children; when it is no 
longer efficacious, give Chamom. or Bellad. 

4. Glonoin. for toothache from taking cold, after having been 
overheated, if the beating of the pulse is felt in all the teeth, or a 
drawing in all the teeth; pain extending to whole right side of 
face, having waves of spontaneous exacerbation, without being 
influenced by anything specially. 

5. Chamom., particularly in children — and in persons who are 
frequently vexed, and who drink much coffee — also in females 
before menstruation; pain in hollow teeth, after taking cold 
when in perspiration, or when the patient is very irritable and 
inclined to cry; when the pain is insupportable, and aggravated 
periodically, worse during the night; when no particular tooth 
can be pointed out as the painful one; or when the tooth is hol- 
low and loose, and feels as if too long; or when the pain extends 
through the whole set, and every tooth feels too long; also when 
it extends through the jaws into the ear, and through the tem- 
ples into the eyes; when there is crawling continually, or scrap- 
ing sensation in the nerve of the hollow tooth, after which the 
pain increases; drawing and tearing, or boring and throbbing 
pain; when at its height, the pain is stinging and jerking, and 
extends to the ear; the patient cannot bear the warmth of the 
bed, and the pain generally commences soon after meals, particu- 
larly after eating or drinking anything warm ; when it grows 
much worse after drinking cold water — also after coffee; cannot 
be relieved by anything but dipping a finger into cold water and 
applying it to the tooth; when, while the pain lasts, the cheek 
is red and hot, or the cheek and gums are swollen and of a light 
red color; when the glands under the chin are painful and swol- 



ODONTALGIA, TOOTHACHE. 259 

Jen, accompanied with great weakness, particularly in the joints; 
with pain in the articulation of the jaw on opening the month, 
extending to the teeth. 

6. Nux mosch. suits children, women — particularly during preg- 
nancy — and all people with a cool, dry skin, who never perspire; 
for pains from taking cold in damp, cold weather, or from the 
night-air; for pains which get worse if air, particularly cold, 
damp air, is drawn into the mouth ; if warm water or warm ap- 
plications ease the pain; for toothache which is increased by the 
shaking of the body in going up or down stairs, if the pain com- 
mences on the right side and goes to the left; for pains as if a 
tooth were wrenched out; worse from much talking; the teeth 
become easily blunt. Frequent yawning, sleepiness and swoon- 
ing; profuse menstruation. 

7. -Nux vom. for toothache in persons of a hasty temper, with 
ruddy complexion, who love coffee and ardent spirits — have little 
out-door exercise, or who have taken cold ; when a healthy tooth 
is painful and feels loose, or the teeth seem too long, with jerk- 
ing, shooting pains in the lower jaw; a drawing pain extending 
into the temple, or a pain from a hollow tooth, affecting the 
wdiole face and even* the bones, or extending over the whole side; 
or for drawing and burning pains in the nerves of a tooth, as if it 
were wrenched out, accompanied by violent stitches, which affect 
tin 1 whole body, particularly on inspiration; when a dull pain in 
the bones changes to a tearing pain, which passes through the 
teeth and jaws, or where there is a boring, gnawing, tearing pain 
on one side; sometimes jerking or rheumatic pains, attended 
with a pricking sensation ; when they chiefly commence in bed 
or in the evening, preventing chewing, grow worse or return as 
sonn as the mouth is opened in the cold air; or when reading or 
thinking; or when the tearing pains become worse from drink- 
ing anything cold and better from external warmth ; in general 
the pains are worse after eating and exercise ; when along with 
the tearing pains the glands beneath the lower jaw are painful, 
ami particularly when a swelling appears on the gums, which 
seems about to burst. 

8. Pulsat. for persons of a mild, quiet, timid disposition, or for 
women and children of a fretful temper; when the pain is only 
on one side; for toothache which is prevalent in the spring, ac- 
co ipanied by earache and headache, confined chiefly to one 
side; when there is a stinging pain in the decayed tooth, accom- 



260 TEETH. 

panied by great sensitiveness of the left side of the face, extend- 
ing to the ear, with heat in the head and chills over the whole 
body; but particularly when there is a gnawing pain in the 
gums, and pricking as of pins, with tearing and jerking in the 
tooth itself, as if the nerve were stretched and then suddenly re- 
laxed; or for jerking or tearing in the tooth as if it would start 
from the jaw, and aggravated by cold water, the heat of the bed, 
a warm room, or by taking anything warm into the mouth ; cold 
air relieves it — the toothache always ceases entirely in the open air, 
but returns in the warm room and gets worse; worse when sitting, 
better when walking about — worse from picking the teeth, better 
from pressure — chewing does not make it worse; it comes on 
mostly towards evening, rarely before, and is accompanied by 
chilliness and pale face, or with congestion of blood to the head ; 
or with heat without thirst; especially for toothache caused by 
drinking chamomile tea. 

9. Ignat. in cases where the foregoing remedies appear to be 
indicated, but are insufficient, and the patient is of a more tender 
and sensitive disposition, sometimes cheerful, at other times in- 
clined to tears; particularly for persons who grieve much; when 
the jaw-teeth feel as if crushed; when there is a boring pain in 
the front teeth, and a soreness in all the teeth; worse after drink- 
ing coffee, after smoking, after dinner, in the evening, after lying 
down, and in the morning on awaking. 

10. Hyosc. in very sensitive, nervous, excitable persons; the 
pain almost drives the patient mad — it is a tearing or throbbing, 
extending to the cheeks and along the lower jaw; or there is a 
tearing, raging pain in the gums, with a buzzing sensation in 
the tooth, which is loose, and feels, when chewing, as if it w r ere 
coming out; or jerking, throbbing, drawing, tearing, which ex- 
tends to the forehead; violent tearing pains in different teeth, as 
if the blood were pressed into them, occasionally accompanied by 
flushes of heat, with determination of blood to the head; it is 
aggravated by cold air; generally comes on in the morning, and 
is sometimes accompanied by jerking in the fingers and arms, 
especially in persons who are subject to convulsions. 

11. Bellad. is frequently best adapted to females or children, 
particularly when the pain and anguish cause great restlessness, 
running about, or where there is depression, and a disposition to 
cry; when the teeth and gums are painfully sensitive; when bit- 
ing produces a feeling as if there were ulcers at the roots, with 



ODONTALGIA, TOOTHACHE. 2G1 

stinging, cutting, jerking, tearing pain; and more especially for 
a (hawing pain, which is worse after going to bed, and during 
the night; or for pricking pains in a hollow tooth, day and 
night; or a pain in a hollow jaw-tooth, as if too much blood 
were forced into it, with heat in the gums and throbbing in the 
checks — nothing mitigates the pain but picking the gum until it 
bleeds; or the gums are swelled, with burning and stinging 
pains, discharge of much saliva, the cheek swelled, sometimes 
the eyes hot and the throat dry, with great thirst — frequently 
the pain returns in the morning on awaking, or recommences 
some time after dinner; the teeth ache when exposed to the open 
air, when touched, from biting, when food or hot liquids come 
in contact with them — pressing hard upon the cheeks sometimes 
gives relief. 

12. China, for mothers who are nursing — or persons who, other- 
wise cheerful, become cross and irritable ; the teeth are covered 
with dark sordes ; the pain comes on periodically, and is throb- 
bing, tearing, jerking or drawing, with great pressure, as if the 
blood were forced into the teeth, or boring and numbness about 
the teeth — worse on motion or when touched, and returning on 
exposure to a draught — the gums swell, the mouth is dry, there 
is thirst, the blood rises to the head, veins of the forehead and 
hands swell, and the sleep during the night is uneasy, although 
the pain is not so great. 

13. Mercur., for children ; in general when there are tearing 
pains in several teeth at once, in hollow ones and those adjoining 
them — the pain affects the whole side of the face, or drawing and 
stinging pains extend to the ear ; it is particularly troublesome 
during the night; or for excruciating jumping pains in the teeth, 
especially at night, with stitches extending to the ear and the 
head, which drive the patient out of bed ; also for stinging pains 
in a decayed tooth, worse after eating or drinking anything cold 
or warm ; the pain is generally increased by cold, and particu- 
larly by damp air, is less severe when in a warm place, or when 
the cheek is rubbed — sometimes the air, when rushing in, causes 
pain in the front teeth ; or the toothache is only felt during the 
day and ceases during the night, and is followed by perspiration, 
and in the morning the same pains return again, in paroxysms, 
with longer or shorter intervals, alternating with giddiness or 
tearing in the limbs ; the teeth are almost always loosened, the 
gums swell or become white and ulcerated, are detached from the 



262 TEETH. 

teeth, burn and ache when touched ; or they begin to itch, to 
bleed and to suppurate, with tearing through the roots of the 
teeth, or with painful swelling of the cheeks. 

14. Hepar, after Mercur. or Bellad., when the painful swelling of 
the gums continues, or for a throbbing pain as if blood were 
entering the tooth, or a drawing pain ; the pains worse after eating, 
and in a warm room, or at night. 

15. Carb. veg., when Mercur. or Arsen. gives some relief, without 
effecting a perfect cure; also in persons who have taken much 
calomel, particularly when the gums bleed, and are detached 
from the teeth ; the teeth are loosened, become ulcerated, and 
ache when touched by the tongue; worse after eating, with draw- 
ing and tearing pains in the incisors. 

16. Sulphur is most suitable for jumping pain in hollow teeth 
— extending to the upper and lower jaw, or to the ear ; for swelling 
of the gums, attended with throbbing pain, bleeding of the gums, 
and swellings around old stumps ; for toothache in the evening, 
or in the air, from draught, worse when rinsing the mouth with 
cold water. 

17. Phosphor, for toothache from washing or from having had 
the hands in cold or warm water. 

18. Cepa for toothache with cold in the head, which gets better 
when the catarrh becomes worse, and which gets worse when the 
catarrh ceases ; from damp, cold weather, and wind ; it commences 
on the left and goes to the right side ; is worse in the warm room ; 
throbbing, drawing, pressing pains, with swelling of the cheek ; 
worse when chewing ; better from cold w»ater ; the teeth become 
yellow ; for people who have an offensive breath, or who are fond 
of being in the open air and like to wash themselves frequently. 

19. Arseuic. when the teeth are loose and elongated, with con- 
stant jerking or burning, and tearing in the gums, worse when 
touched, when lying on the affected side, and when at rest, and 
also from cold; the pains are mitigated by the heat of the stove, 
by hot applications, or by sitting up in bed ; it is particularly 
indicated when the pains are very debilitating. 

20. Ant. crud. is the principal remedy for pains in hollow teeth, 
of a boring, digging, tearing, jerking character, which sometimes 
penetrate into the head; the pains are aggravated in the evening 
in bed, after eating, by cold water; and better when walking in 
the open air. 

21. Bryon. for passionate, irritable, cross, obstinate people ; pain 



ODONTALGIA, TOOTHACHE. 203 

occasionally in hollow but more frequently in healthy teeth ; 
shooting pains with twitching' towards the ear; tearing pain ex- 
tending to the cheek, and acute pains as if caused by an exposed 
nerve ; sensitiveness and pain in the decayed teeth from contact 
with the air; the teeth feel as if too long and loose, and when 
chewing they feel as if they would fall out. The pains are 
aggravated by smoking or chewing tobacco; from the introduction 
of any thing warm into the mouth — better in the open air — 
sometimes relieved by cold water, but only momentarily, and 
also when lying on the affected cheek, but worse when lying on 
the other. Likewise, when the pain shoots from one tooth into 
the other, and also into the head and cheeks. 

22. Rhus for the same painful sensation of elongation and 
looseness of the teeth, as Bryon., and also when they feel as if they 
Avere asleep, (China, Dulcam.,) and hollow, or sensitive to the air; 
the gums are swollen, burn, and itch like an ulcer, or they are 
sore and detached from the teeth ; for jumping, shooting, or 
drawing pain, as if the teeth were being torn out, (Pulsat.) or 
pressed into their sockets, (Staphis.) or for slow pricking or 
throbbing or tearing in all the teeth, extending into the jaws 
and temporal bones, with a painful soreness of one side of the 
face, from taking cold, or from vexation, worse in the air, in- 
sufferable during the night, and mitigated by heat ; sometimes 
accompanied by an offensive smell from the carious teeth. It 
suits best for quiet persons (unlike Bryon.) wdio are disposed to 
sadness and melancholy, or are easily agitated and frightened 
(similar to Bellad.). 

23. Staphis., when the teeth become black and hollow, the gums 
pale, white, ulcerated, and swollen — aching when being touched ; 
intense gnawing, drawing, or tearing pains in decayed teeth, par- 
ticularly in the roots, or extending through a whole row, or when 
the pain shoots from a hollow tooth into the ear, with throbbing 
in the temple — worse in the open air, from drinking any thing 
cold, from eating, and particularly during the night or toward 
morning. 

24. Laches., pain in all the decayed teeth during rush of the 
blood to the head ; drawing, tearing, throbbing, boring pain in 
the jaw-bones; hollow teeth feel too long; pain extending down 
the throat ; better when pus is discharged ; gums swollen, bleed- 
ing easily, or they are bluish-red, beating and burning, worse 
from any thing warm; toothache worse after warm and cold 



264 TEETH. 

drinks, after eating and awaking ; with headache, beating over 
the eyes, stitches in the ears, swelling of the cheek ; pains in the 
limbs of the opposite side, chills, fever, and thirst. It is par- 
ticularly suited for colds in damp, warm, spring weather; during 
menstruation, the smaller the discharge the greater the pain, at 
the cessation of the menstruation ; for melancholic and choleric 
persons, for persons of vivid imagination ; after long-continued 
grief, and after the abuse of mercury. 

25. Phosph. ac. is suitable for bleeding and swollen gums; tear- 
ing pains which are worse when warm in bed, and also from 
heat and from cold, burning in the front teeth during the night ; 
pains from hollow teeth, extending into the head. 

26. Ap. vir. for the most violent pains in the gums, also for 
jerks and throbbing in the molars, with involuntary, sudden bit- 
ing together of the teeth, headache and bleeding of the gums. 

27. Silic. for tedious, boring, tearing, pains, day and night, worse 
during the night, spreading over the whole cheek, also into the 
bones of the face; discharge of offensive matter from openings 
near the roots of the teeth, or from the gums; swelling of the jaw. 

28. Dulcam. is sometimes useful for toothache proceeding from 
cold, particularly when accompanied by diarrhcea, and when 
Chamom. does not answer; also when there is at the same time 
confusion of the head, or when the toothache is accompanied by 
profuse salivation, (similar in this to Bellad. and Mercur.) and the 
teeth feel blunt. 

29. Calcar., for toothache in pregnant females; pains in hollow 
teeth, especially around loose stumps; pressing, drawing, jerking 
soreness; drawing, pricking, rooting, gnawing, grubbing, throb- 
bing pains, with swelled gums, which are sore, bleed easily, throb 
and pain; it is only suitable when there is determination of blood 
toward the head, particularly during the night; when the pains 
are caused by taking cold, or are aggravated by cold or a draught 
of air; the patient can neither bear warm nor cold drinks — even 
noise makes it worse. Fistula dentalis. 

30. Caustic, for toothache arising from breathing in the open 
air, generally attended with stinging, throbbing pain, and a feel- 
ing of soreness; or the teeth feel painfully loose and lengthened, 
as if forced out of their sockets, (Arnica, Phosph. ac): when there 
are ulcers at the roots of the teeth, the gums suppurating are 
swollen and very tender. The pain frequently affects the whole 
of the left side of the face, especially at night when the patient 



SWELLED FACE. 265 

lies on it, and is equally sensitive to heat and cold ; in long-con- 
tinued or often-returning colds. After grief; melancholy mood; 
profuse, badly smelling sweat at night. 

31. Clemat, drawing, stitching, worse at night; better for a short 
time by holding cold water in the mouth, or sucking at the tooth, 
and in the open air. 

32. Kali bichr., pain in molar bones worse from coughing. 

33. Kali carb., stitch pain, and tearing up into the head and 
eye, with dizziness; chilliness, dry skin and bad alkaline smell 
from mouth; worse from chewing. 

34. Magn. carb. and phosph., pain is worse at night, drives out of 
bed. 

35. Natr. sulph., pain is better from holding cold water in 
mouth, and is brought on again by taking hot water or hot 
coffee in the mouth. 

36. Petrol., abscess at root of tooth, with swelling of left lower 
jaw, painful to touch and on stooping. 

37. Plant, maj., aching in decayed teeth, or shooting up left side 
of face; face red. Is a popular remedy. 

38. Sabad., hot or cold food or drink, also cold air produce or 
increase the pain. 

39. Sepia, chronic cases; caries; waterbrash during pain; me- 
climaxis; leucorrhoea. 

40. Spigel., pain leaves during eating and reappears afterwards, 
with palpitation of the heart. 

41. Sulph. ac, pain begins slowly to increase, growing to an al- 
most unbearable degree when it suddenly ceases. 

42. Thuja, with decay of the teeth commencing close to the 
gums. 

Swelled Face. 

When the cheek remains swollen after the toothache has ceased, it 
may be removed by giving Pulsat, if Mercur. or Chamom. have 
been previously taken for the pain; or Mercur. after Pulsat. or 
Bellad.; or Bellad. after Mercur.; or Sulphur, after Bellad., Bryon., 
Arsen., etc. If the swelling is red, as in erysipelas, Mercur. should 
be given; if less red, but hard and stiff, Arnica. Hepar, when 
the swelling begins to soften, and appears as if about to sup- 
purate, followed by a dose or two of Laches., if Hepar does not 
effect a speedy abatement of the swelling, and then by Hepar 
again or by Mercur., if the latter have not been taken before. 



266 



THE TONGUE. 



To this remarkable piece of furniture of the human economy- 
great attention has been paid by physicians of all shades and in 
all times. And, indeed, it often presents quite characteristic 
diagnostic as well as therapeutic hints. The most important of 
these features are the following : 

1. Its Color. 

It is either too red all over, as in scarlet fever, with considerably 
raised papillae — whence the name strawberry tongue — or red and 
dry, as in inflammations of the brain and its membranes; in in- 
flammation of the thoracic viscera and mucous membranes of the 
stomach and intestines; or red on the edges and on the tip, or a 
red, dry streak in the middle of the tongue in typhoid fevers, or red, 
clean and glossy, indicating great fever heat, congestion to the 
head, impending delirium, and, in gastric fevers, the transition 
into the typhoid state; and if, at the same time, cracked, ulcera- 
tion of the bowels; or red, moist and smooth, in chronic affections 
of the stomach. 

A pale tongue is found in chills; in spasms; after loss of vital 
fluids; in chlorosis, dropsy, and general exhaustion. When it 
sets in in exanthematic, gastric, or bilious fevers, it denotes a 
fatal issue. 

A lead-colored tongue is found in cholera, in mortification of the 
lungs and stomach, in scirrhus of the tongue. 

A lead-colored tongue, with thrush, denotes impending death 
under all circumstances. 

A bluish tongue is a sign of impeded circulation of blood, and, 
therefore, it may be found in paroxysms of asthma, whooping- 
cough, croup, bronchitis, pneumonia, heart diseases, dropsy of the 
chest, and cyanosis. Scurvy and mercurial inflammation of the 
tongue have also a bluish hue. 

2. Its Humectation. 

A moist tongue is, in general, a favorable sign. But in putrid 
fevers, with exhausting perspiration, it has no such favorable 
meaning. 

A constantly moist tongue in soporous conditions denotes great 
exhaustion. 

A dry tongue is found in a great many different morbid condi- 



EXAMINATION OF TONGUE. 267 

tions, especially in feverish affections, particularly in such as 
have a tendency to sensorial disturbances. 

Great dryness of the tongue in typhus cerebralis is, according 
to Schoenlein, an unfavorable sign. 

Dryness of the tongue in infants is a forerunner of thrush or 
internal inflammation. 

3. Its Temperature. 

A hot tongue is found in congestive and inflammatory states of 
different parts of the body; in infants before thrush appears. 

A cold tongue is found in chills, violent spasms, after great loss 
of blood, internal mortification, apoplexy, cholera. In fevers it 
denotes greatest prostration and impending death. 

4. Its Covering or Coating-. 

We must bear in mind that the tongue is coated or furred 
without indicating any disordered state of the system — in the 
•morning by an empty stomach; after siesta; after night- watch- 
ing, and with habitual smokers of tobacco. 

A coating of the root of the tongue does not mean much ; in a 
slight degree everyone has it, even in the best of health. 

A coating on the tip of the tongue is said to be found in phthis- 
ical persons. 

One-sided coating is said to be found in one-sided complaints, as 
prosopalgia, paralysis; in one-sided lung diseases; in affections 
of the liver and spleen. 

A patchy or map tongue, the so-called pityriasis lingua?, is pro- 
duced merely by a stouter layer of epithelium around the places 
of thinner covering. A systemic cause for this affection is not 
known, although it may possibly be connected with some abnor- 
mal states of the stomach. 

A thick, white coating occurs most extensively in affections of 
the fauces ; but also in gastric derangements. 

The yellow coating is generally believed to be bilious; single 
yellow streaks on a white-coated tongue indicate obstinacy of the 
disease. 

A peculiar buff leather appearance is presented in cases of enteritis 
and hepatitis; also in tonsillitis. 

A dark brown coating exists in malignant fevers, and in hsemor- 
rhages from the mouth. 

A black coating, in dysentery, indicates exhaustion — mortification 



2G8 TONGUE. 

— death. In jaundice it denotes organic diseases of the liver, 
spleen, snch as induration, tubercles, abscesses. In small-pox it is 
quite an unfavorable sign. 

5. Its Form and Size 

We find a large, long tongue most conspicuously in chronic hy- 
drocephalus and cretins. 

A small tongue, if not congenital, in atrophy, consumptive dis- 
eases, and long-standing paralysis of the tongue; especially if 
caused from an irritation of the brain or spinal marrow. 

A sudden diminution in size denotes, in inflammatory diseases 
of the lungs and liver, formation of abscesses; also general ex- 
haustion ; especially in putrid and typhoid fevers. 

A gradual decrease, in acute diseases, denotes gravity and ob- 
stinacy of such diseases, and is a sign of a dangerous affection of 
the brain. (Sprengel.) • • 

A broad tongue is found in rhachitis, scrofula, inclination to 
abdominal affections and in intermittent fevers. 

A narrow, pointed tongue is said to.be found in persons who 
are subject to spitting of blood, tuberculosis, and internal in- 
flammations. 

A thick, swollen tongue is found in rhachitis, cretins, chronic 
dropsy of the head, in obstinate dyspnoea and chronic inflamma- 
tion of the mucous membrane of the stomach ; also in intermit- 
tent fevers, catarrhal affections, mercurial salivation, inflamma- 
tion of the tongue, in old drunkards; after death by strangulation 
or suffocation. 

A swollen and heavy tongue in old age is the forerunner of apo- 
plexy; the same in drunkards. In fevers, if associated with dry- 
ness and stammering speech, it denotes congestion of the brain. 
In croup, pleurisy and pneumonia, it is a bad sign, just as bad as 
its sudden diminution, without improvement of the other symp- 
toms. (Hippocrates.) 

A thin, like a small, tongue is found in atrophy, consumptive 
diseases. 

Tumors on the tongue, if hard, brownish-red, with bluish blood- 
vessels interwoven, are of a scirrhous nature. 

Single lumps and fleshy excrescences on the tongue are found in 
elephantiasis. 



EXAMINATION OP TONGUE. 



2G9 



6. Its Consistency. 

We find a hard tongue associated with great dryness of the 
tongue in congestion, inflammation, in fevers, in tonic spasms, in 
scirrhus and other degenerations of the substance of the tongue. 

A soft tongue we find in catarrhal affections, in chronic mucous 
diarrhoea, gastric derangements and in paralysis of the tongue. 
When soft, the teeth generally show their imprints on its sides — 
often found after mercurial poisoning. In brain diseases a soft 
tongue is a bad sign. 

7. Cracks and Fissures 
On the dry tongue, sometimes deep, bleeding and suppurating, 
are found in typhoid fever, in small-pox, dysentery. 

8. Paralysis 
Of the tongue, which manifests itself by an imperfect, stammer- 
ing speech, is often the consequence of apoplexy, softening, or 
other affections of the brain. 

Its immobility and its trembling are signs of torpor of the brain, 
especially in consequence of typhoid conditions, puerperal fever 
and septicaemia. 

THERAPEUTIC HINTS.— A red tongue all over with considerable 
raised papilla? : Arum triph., Bellad., Hyosc, Merc, corr., Tart. emet. 
Red, glistening tongue : Kali bichr., Laches. 
Red tip : Arg. nitr., Morphium. 
Red tip in the shape of a triangle : Rhus tox. 
Red tip, undefined and red borders : Sulphur. 
Red borders : Bellad., Bryon., Morphium, Nux vom., Sulphur. 
Red streak in the middle of a yellowish coated tongue : Ver. vir. 
Lead-colored tongue : Arsen. 
Bluish tongue: Arsen., Digit., Mur. ac, Thuja. 
White, thick coating: Ant. crud., Arsen., Bryon. and many others. 
Whole tongue as if painted white: Glonoin. 
White coating with cracks across the middle : Kobalt. 
White coating only on one side : Rhus tox. 
A white streak on both sides : Caustic. 
In the middle only : Bryon., Phosphor. 
On the root only, strongly marked : Sepia, 

Map tongue: Arsen., Lac. vac, Laches., Natr. mur., Nitr. ac, Tarax., 
Yellow coating: Many remedies. 



270 TONGUE. 

Brown coating: Arsen., Bellad., Cactus, Coccul., Kali bichr., Merc. 
prot, Plumbum, Secale, Silic, Spongia, Sulphur. 

A dry, white tongue, without thirst: Bryon., Pulsat. 

Dry, white, without thirst and paralyzed : Nux mosch. 

Dry, white, and feeling as if burnt or scalded: Psorin., Pulsat, Sepia. 

Dry and cracked : Arsen., Bellad., Chamom., Kali bichr., Laches., Rhus 
tox., Ver. alb. 

Dry and red: Arg. nitr., Bellad., Chamom., Hyosc., Laches., Lycop., 
Morphium. 

Dry, red and cracked at the tip: Kali bichr., Laches., Rhus tox., 
Sulphur. 

A black coating: Arsen., China, Elaps., Laches., Mercur., Opium, 
Secale, Ver. alb. 

A soft tongue, with, imprints of teeth: Mercur., Rhus tox., Stramon. 

A clean tongue with gastric and other derangements: Cina, Digit. 

Trembling and inability to protrude the tongue in typhoid condi- 
tions: Laches. 

Heavy, trembling tongue, with falling of lower jaw in typhoid 
conditions: Lycop. 

Spasmodic darting of the tongue out of mouth in typhoid condi- 
tions: Lycop. 

Protruding of tongue with silly expression in diphtheria: Lycop. 

Protruding, cold and lame: Hydr. ac. 

Paralysis of tongue: Aeon., Arsen., Baryt. carb., Bellad., Caustic, 
Dulcam., Graphit,, Hyosc, Laches., Nux mosch., Opium, Plumbum, 
Stramon. 

Difficulty of moving the tongue : Anac, Bellad., Calc carb., Lycop. 

Heavy tongue : Anac, Bellad., Carb. veg., Colchic, Lycop., Mur. ac. 
Natr. mur., Plumbum. 

Stiffness of tongue: Borax, Colchic, Euphras., Laches., Natr. mur. 

Glossitis, Inflammation of the Tongue. 

We understand by this name an infiltration of the parenchyma 
of the tongue, which is either confined to only a portion of the 
tongue, Partial glossitis, or pervades the entire organ. Glossitis 
diffusa universalis. A mere superficial inflammation of the mucous 
membrane of the tongue belongs as part to inflammatory pro- 
cesses of the general mucous membrane of the mouth. 

The most important symptom of an Universal glossitis is the 
rapid swelling of the tongue, which in a day or two may acquire 



GLOSSITIS. 271 

such dimensions, as to prevent by its pressure upon the pharynx 
and epiglottis not only swallowing, but also breathing and to 
cause death by suffocation in a few hours. The patient is seized 
with paroxysms of asphyxia, as in croup, becomes cyanotic and 
suffocates, if breathing is not restored. The tongue, having not 
room in the mouth, also protrudes, and presses sidewise between 
the back teeth, causing deep indentations with immediate dis- 
position to the formation of ulcers. The neighboring lymphatic 
and salivary glands also become swollen. The pain is severe, 
and extends to the ears and throat. Its course is rapid, termin- 
ating either, as before stated, in death by suffocation, or in a 
gradual subsidence of the swelling, or in the formation of an ab- 
scess, which mostly breaks through the surface of the tongue. 
Even gangrenous destruction of large portions of the tongue has 
been observed as a result of mercurial glossitis, and at times there 
remain circumscribed indurations, with a disposition to renewed 
attacks.. 

Partial glossitis usually commences as a painful tumor from 
the size of a pea to that of a bean on the back part of the tongue, 
which gradually suppurates, finally breaks and discharges. It 
is not attended with any special disturbance of the general 
health. 

The Causes of a genuine parenchymal glossitis are not clear 
by any means. Some have recorded epidemics of this disease ; 
others have observed it as a consequence of anthrax poison ; 
others as the result of mercurial poisoning, and still others as the 
effect of the sting of a wasp, bee, or hornet. Sporadic cases of 
glossitis have in nowise been etiologically explained. The most 
fatal are those caused by the poison of anthrax — Glossanthrax — 
or carbuncle of the tongue. 

THERAPEUTIC HINTS.— If anthrax, bee, wasp and hornet- 
stings, and mercurial poisoning are set down as causes of glos- 
sitis, we naturally will find powerful remedies for this disease in : 

Anthrac., especially when there is great burning and a disposi- 
tion to gangrene ; after Arsen. 

Apis, when there is stinging and burning pain, with blisters 
on the tongue. 

Merc, sol., when there is ulceration, and great flabbiness of the 
tongue, with salivation. 

Besides compare : Plumbum, Ran. seel., Sepia, and 



272 TONGUE. 

Ar§en., great burning and tendency to gangrene. 

Laches., blisters which change into ulcers. 

Petrol., fetid salivation. 

Sulphur, ulcerated tongue. 

Camphora, or Natr. mur., when caused by an insect sting. 

Cupr. ac, Calc. carb., Hepar, Nitr. ac, Sulphur, after abuse of mer- 
cury. 

Cauthar., after scalding the tongue. 

Calc. carb., Carb. veg., Conium, Hepar, Lycop., Mezer., Silic, Sulphur, 
when indurations remain and the case becomes chronic. 



Cancer of the Tongue 

Is of the epithelial kind and commences usually at the edge, near 
the tip of the tongue, as a small, hard lump, which after a while 
forms an ulcer of a roundish shape, with raised edges and un- 
even bottom. It distinguishes itself from every other ulcer by 
its continuous encroachments, by its hard, lardaceous bottom, 
by the viscid, milky juice which can be squeezed out by pressure 
upon its edges, and by the lancinating, boring, burning pains, 
with which it is attended, robbing the patient of rest at night, 
and not unfrequently leading him to suicide. By-and-by the 
adjacent parts of the tongue begin to swell, and the cancer itself 
spreads either upon the superior or inferior surface of the tongue. 
In its further progress the motion of the tongue becomes im- 
peded, and the swallowing of solid food impossible. A great 
deal of saliva is secreted, and as the swallowing is painful and 
difficult, the patient spits all the time. The glands under the 
tongue, and also the lymphatic glands of the neck become af- 
fected; they swell and harden; the tongue becomes firmly at- 
tached to the bottom of the mouth, so that its motion is almost 
destiwed ; it gradually is transformed into a thick, shortened, 
misshapen lump, with round protuberances upon it, which break 
and emit a terrible smell. Sometimes the glands of the neck 
and the region of the parotid glands swell to such an extent 
that it is impossible for the patient to open the mouth, and he 
gradually sinks under excruciating suffering, starvation and ex- 
haustion. The disease is slow, lasting from one to three years. 

THERAPEUTIC HINTS.— Compare Arsen., Caustic, Carb. an. and 
veg., Conium, Hydrast., Laches., Nitr. ac, Phytol., Sepia, Silic., 
Sulphur. 



THE SALIVARY GLANDS AND THEIR DUCTS. 273 

THE SALIVARY GLANDS AND THEIR DUCTS. 

There are three pairs of such glands: the parotid, which is situ- 
ated near the ear on each side; the submaxillary, lying in the 
posterior angle of the submaxillary triangle of the neck on each 
side; and the sublingual, which is imbedded beneath the mucous 
membrane of the floor of the mouth on each side of the frsenum 
linguae. The excretory ducts of the parotid, called Stenon's ducts, 
open at the internal surface of the cheeks, opposite the second 
molar tooth of the upper jaw; those of the submaxillary, called 
Wharton's ducts, open by the side of the frsenum linguae; and 
those of the sublingual, which are seven or eight in number, also 
open in this same locality. The product which they pour forth 
into the mouth is the saliva. This very important fluid is greatly 
altered by disease ; but still, all the microscopical and chemical 
researches have failed to reveal any facts which can be considered 
of diagnostic value. 

The saliva varies in Quantity. 

There is normally less secretion in the first four months of in- 
fancy, and also in the last years of old age. But its secretion 
may be abnormally lessened by deficiency of beverage, or by dif- 
ferent pathological conditions, which induce copious secretions of 
fluids, either through the skin, or kidneys, or serous membranes. 

An increase of saliva (salivation, ptyalism) may be caused by 
various drugs, as our Materia Medica shows ; but the most known 
and the most virulent is that caused by mercury, being accom- 
panied by a most sickening, penetrating smell from the mouth, 
swelling and inflammation of the gums, loosening and falling 
out of the teeth, stomatitis, and ulceration of the mucous mem- 
brane. We find an increase of saliva also in many diseases of 
the cavity of the mouth, of the tongue, in caries of the teeth, in 
necrosis of the jaw, during the eruption of the milk teeth, in acute 
and chronic irritations of the parotid and submaxillary glands, 
during the eruption of small-pox in the mouth ; sometimes at 
the commencement of typhus ; in consequence of irritation of the 
trifacial, the facial and the glosso-pharyngeal nerves ; in conse- 
quence of diseases of the stomach, of the pancreas and spleen ; in 
intermittents ; during pregnancy, menstrual disturbances, cli- 
maxis and in many hysterical conditions. 

The Color of the saliva may also be changed. 

A blue color has been observed in slow poisoning cases by lead. 

18 



274 SALIVARY GLANDS. 

Yellow, even greenish saliva has been found in liver complaints 
and jaundice. 

A red, bloody saliva in different morbid conditions, when it be- 
comes mixed with blood, as in haemorrhage from the mouth or 
nose, inflamed and bleeding gums, etc. But has also been found 
in suppression of hsemorrhoidal and menstrual discharges. After 
external injury of the head, bloody saliva is, like bleeding from 
the ears, a sign of fracture of the skull bones. 

Its Chemical reaction in a healthy state is slightly alkaline; if 
it be acid, it indicates a disturbance in the digestive organs. It 
may also become acid in diseases of the intestines, in rachitis, 
gout, and in scrofulous conditions. In a normal state, saliva 
contains more or less sulphocyanide of potash or soda, which 
can be easily detected by adding a drop of sesquioxide of iron 
to some saliva, which changes it to a deep-red color. During 
small-pox this substance seems to be wanting in the saliva, and 
be present in the contents of the pustules. 

Parotitis. 

1. Its idiopathic form is known under the name of Mumps. It 
frequently appears epidemically, and is contagious. Children 
from two to fifteen years of age are most prevalently affected, 
while nurslings and old people are exempt. One attack protects 
against re-infection. 

Its outset may not be marked by any precursory symptoms; 
sometimes it is preceded by pains in the limbs, headache, loss of 
appetite, chilliness and feverishness towards evening; sometimes 
by vomiting and diarrhoea, great anxiety, fainting, even convul- 
sions. Its period of incubation is estimated from about six to 
eight or ten days. The inflammation of the gland manifests 
itself by pain in the region where the affected gland is situated. 
especially when opening the mouth, and a swelling below the 
lobe of the ear — almost always only on one side. — which rapidly 
increases, and gives to the face an odd look. This swelling is of 
a doughy feel and never sharply circumscribed: it is caused by 
enlargement of the gland itself, and still more by an cedematous 
infiltration of the adjacent connective tissue, and may. indeed. 
attain to such an enormity that the movements of expression of 
the face become entirely suspended, giving to the patient an 
idiotic appearance. It also extends to the tonsils, the pharynx. 



PAROTITIS. 275 

and may invade even the larynx, when corresponding symptoms 
will develop. The skin over the swelling is either pale, waxy, 
glistening or somewhat reddened, or of a purplish hue. 

Besides stiffness, pain and incapability of all movements which 
talking, chewing and swallowing would require, the patients are 
sometimes troubled with hardness of hearing, pain in the ear, 
salivation or great dryness in the mouth, loss of appetite, vomit- 
ing, constipation and even with symptoms of cerebral hyperemia, 
the result of pressure upon the veins in the neck. 

As a rule only one parotid is thus attacked ; sometimes, how- 
ever the inflammation goes from one side to the other succes- 
sively, and this lengthens the course of the disease for a few 
days ; a simultaneous attack of both glands has not been observed. 

The elevation of temperature and increased rapidity of the 
pulse, in most epidemics, is of no great amount; by the fourth 
or fifth day usually all fever has left; in some cases, however, a 
rise of temperature in the evening to 104° F. for several days, 
has been observed. 

In most cases the local and general symptoms have culmi- 
nated in from three to six days, when they gradually subside in 
about the same length of time, so that the entire morbid process 
is completed in from one to two weeks. 

At times, however, we meet with complications in pubescent 
youths and men, consisting of an inflammation of one testicle, 
most commonly that of the right side, or of both sides successively, 
in the same manner as a bilateral parotitis. It does not set in 
until the parotideal inflammation has ceased, and is attended 
with a renewal of the fever. In some cases there is an ejDididy- 
mitis combined with an acute hydrocele and oedema of the subcu- 
taneous connective tissue of the scrotum; in severe cases there is 
also a gonorrhoea-like discharge from the urethra and burning 
pain during micturition. Patients suffering with gonorrhoea, on 
the contrary, are according to Blondeau, not at all disposed to 
orchitis, and the mumps generally pursues its course free from 
all complications. 

In the female sex a metastatic swelling of the mamma? or the 
external genitals, of the ovaries or of the inguinal glands, have 
been observed, while in still other cases the conjunctiva and mu- 
cous membrane of the throat, urethra and vulva have become 
involved. Some cases terminate in gangrenous destruction of 
the gland for unknown causes. 



276 SALIVARY GLANDS. 

THERAPEUTIC HINTS.— Bellad, bright red swelling, especially on 
right side; fever and brain symptoms. 

Mercur., pale swelling, little fever, often indicated. 

Rhus tox., dark red swelling, especially on left side, or going from 
left to right; restlessness and fever. 

Euph. off., if Rhus tox. should not help, also dark red color, 
with burning and stinging pain. 

Carb. veg., if Mercur. should not be sufficient or should have 
been abused; lingering fever; also when there are hoarseness or 
metastatic symptoms of the stomach. 

Coccul, if Carb. veg. should not relieve the lingering fever. 

Arsen., Aurum, Carb. veg., Nux vom., Puis., in metastasis to testicles. 

Arnica, testicles inflamed; great tenderness; loose stools during 
day; complains of hardness of bed on which he lies. 

Apis, Laches., Pulsat, Sulphur, metastasis to female organs. 

2. The symptomatic form of parotitis, called Deuteropathic or Me- 
tastatic parotitis, is most frequently associated with typhus in all 
its forms, with scarlet fever, measles, and small-pox; with pyaemia, 
puerperal fever, dysentery, typhoid cholera, and in the tropics, 
with yellow fever. 

The swelling of a metastatic parotitis is much harder and more 
defined, and also more prone to suppuration than that of mumps. 
In fact, absorption occurs only rarely in metastatic parotitis : it 
goes on to suppuration or even to mortification, if the patient 
lives long enough. If it breaks in time and discharges fully. 
cicatrization by granulation may follow ; or new abscesses in other 
parts of the gland may form and fistulous openings be the result ; 
or the walls of the abscess may be transformed into an ichorous 
cavity and finally become gangrenescent, involving by degrees 
adjacent parts by further infiltration and gangrene. In the latter 
case the discharge assumes a cadaverous odor and consists of 
gangrenous shreds; the external skin darkens and becomes black. 

Its Prognosis depends much upon the nature of the disease 
which it attends. As a rule it may be stated, "that it is the niore 
unfavorable and dangerous the earlier it appears in connection 
with typhus, scarlatina, etc., while its course is mostly favorable 
when it occurs during convalescence from these infectious dis- 



THERAPEUTIC HINTS.— When suppurating: Arsen., Hepar, Phos- 
phor., Silic. 



RANULA, FROG. 277 

When fistulous openings have formed : Lycop., Nitr. ac, Phytol. 

When indurated : Baryt. mur., Calc. carb., Carb. veg, Clemat, 
Coniura, Iodium, Kali carb., Lycop., Silic, Sulphur. 

When gangrenous: Kreosot., Arsen., Laches. 

After scarlet fever : Arsen., Baryt. mur., China, Kali carb., Laches., 
Lycop.,' Nitr. ac, Rhus tox., Silic. 

Ranula, Frog. 

It consists of a swelling on the floor of the mouth under the 
tongue, either in the middle, or on one side of the frsenurn linguae, 
caused by a widening of Wharton's duct in consequence of ob- 
struction by minute foreign bodies which have become lodged 
there and incrustated. It presents itself on inspection as a soft, 
elastic, fluctuating and transparent kind of blister or bag, whose 
sheath is similar to a fine serous membrane, and the contents of 
which consist of a gluey, transparent, pale-yellowish or brownish 
fluid, of alkaline reaction, and without microscopic elements. It 
varies considerably in size and form, the latter depending some- 
what on the former. When small it is globular ; but as it in- 
creases its shape is modified by the surrounding tissues. Cysts 
and abscesses are also formed in this locality with which ranula 
must not be confounded. 

THERAPEUTIC HINTS.— Compare Bellad., Calc. carb., Fluor, ac, 
Mercur., Mezer., Nitr. ac, Thuja. 

THE TONSILS 

Lie between the two palatine arches and generally project dis- 
tinctly beyond them, though in a variable degree. Their form 
is that of an oval disc, sometimes of a flattened globe. Their size 
varies much, so that no positive volume can be determined on. 
Their free superior surface, being moderately red, presents from 
ten to sixteen round or linear openings, which are barely visible; 
sometimes they are wider and more like fissures. They lead into 
longer or shorter fissures (lacunas, sinuses), running perpendicu- 
larly or obliquely in various directions, and sometimes giving off 
branches. The lacunae are lined with a thin but uniform layer 
of epithelium. The tissue surrounding the lacunas consists of 
follicles and interfollicular tissue. The follicles are composed of 



278 TONSILS. 

reticular tissue, with few capillaries, and of small, round cells im- 
bedded in them. The interfollicular tissue is of an essentially 
similar character, only it is richer in capillaries, and contains 
small arteries and veins. The framework of the tonsils consists 
of a fibrous connective tissue, by which they are also surrounded 
and fastened to different pharyngeal muscles. 

Inflammation of the Tonsils ; Amygdalitis ; Tonsillitis ; 
Angina tonsillaris. 

There is a Simple catarrhal inflammation of the mucous mem- 
brane covering the tonsils, which is in most cases only part of a 
general pharyngeal catarrh. A Lacunal or Follicular catarrh of the 
tonsils is deeper, produces a thin or thick whitish, yellowish, curdy 
substance which, when thick, adheres tightly and consists of epi- 
thelium and pus. It may be confounded with herpetic angina, 
mild diphtheritis, or even with superficial abscess of the tonsil. 
The tonsils in such cases are always more or less swollen and 
the palatine arches inflamed. This morbid process yields mostly 
in a few days after a spontaneous evacuation of the epithelial 
and purulent contents ; or the contents may dessicate, and then 
become foul, or calcareous. Those little, cheesy lumps, which at 
times with some patients, when hawking forcibly, fly out of the 
mouth, are of this origin. In still other cases it may give rise 
by extension to a Parenchymatous amygdalitis, which is character- 
ized by a high grade of congestive hyperemia and serous infil- 
tration, in consequence of which the tonsil, or tonsils — for it may 
be unilateral or bilateral — become enormously swollen. This 
state of things results either in a return to the normal form by 
absorption, or in an infiltration of small cells, both in the in- 
terior of the follicles and between them, and a consequent new 
formation of reticulated substance giving rise to a permanent 
hypertrophy of the tonsils; or in the formation of several ab- 
scesses. Sometimes an abscess forms in the connective tissue sur- 
rounding the tonsils — Peritonsillar or Retrotonsillar abscess — , most 
frequently between the tonsil and the affected palatine arch, 
usually the anterior arch. This affection ordinarily involves but 
one tonsil, sometimes the other, several days afterwards, forms a 
walnut-sized protuberance, which usually terminates in perfora- 
tion, followed by a rapid return to the normal condition. This 
formation of abscesses is commonly known under the name of 
Quinsy. 



TONSILITIS. 279 

111 clinical practice we can not always distinguish between 
these different pathologico - anatomical forms; neither does it 
matter. Either of them, with the exception of the superficial 
catarrhal form, may be accompanied with great pain, swelling of 
one or both tonsils, impossibility of swallowing and talking, of 
opening the mouth or moving the head. They are mostly asso- 
ciated with hypersemia, or collateral oedema of the pharynx, ex- 
tending sometimes into the Eustachian tubes, with pain in the 
ears, or to the larynx, with dyspnoea or paroxysms of suffocation, 
especially on lying down. Fever attends all more severe cases, 
especially those with suppuration ; the temperature may rise to 
104° F., with morning remissions and evening exacerbations. 
There is loss of appetite; sometimes headache, delirium, and 
even convulsions have been observed in children at the com- 
mencement. 

The duration of a superficial and lacunal tonsillitis varies be- 
tween three and eight days, while a parenchymatous amygdalitis 
and a tonsillitis with abscess lasts at least eight days, frequently 
a week and a half, and even as long as two or three weeks. Per- 
sons once affected by tonsillitis are liable to repeated attacks. 
Fatal terminations are exceedingly rare. 

THERAPEUTIC HINTS.— "The much recommended timely open- 
ing of tonsillar abscesses is of little use, because it is very seldom 
successful, and, even when it succeeds, hardly ever relieves the 
patient. It is somewhat different in anterior peritonsillar ab- 
scess ; but even then the relief to the patient is seldom as great 
as after spontaneous discharge. Deep incisions are not advis- 
able, owing to the contiguity of the carotid artery." (Wagner, 
allopathic authority.) 

It is strange, that in some "homoeopathic" works we find the 
use of the Bistory still advocated. 

Amm. nmr., both tonsils swollen ; can neither swallow, talk, nor 
open the mouth ; after taking cold. 

Apis, stinging, burning pain when swallowing; dryness in 
mouth and throat; red, highly inflamed tonsils; cedematous 
swelling of fauces and glottis. Fears open air, yet cannot stand 
the warm room ; thirstlessness. 

Baryt. carb., liability to tonsillitis after slight cold, or suppressed 
sweat of feet; tonsils tend to suppurate; especially right side. 

Bellad., especially right side ; parts bright red ; also swelling of 



280 UVULA. 

the neck, externally, painful to touch and motion; cerebral 
symptoms. 

Hepar, sticking pain as from a fishbone in the throat when 
swallowing ; tendency to suppurate ; after mercury. 

Ignat., in follicular catarrh, almost specific. 

Kali hydr., or Iodium. .(Kafka). 

Laches., especially left side; choking when drinking; fluids are 
driven out through the nose; worse in afternoon, after sleep, from 
slightest touch ; can't bear bed-clothes near the neck. 

Mercur., dark redness; fetid ptyalism; very offensive smell from 
mouth ; aphthae or thick coating on the tongue. 

Plumbum, angina on left side, with copious flow of purplish sa- 
liva and spasms. 

Silic, in stubborn cases where abscesses are forming, yet don't 
break, especially left side. 

Sulphur, when, after the bursting of the abscess, the parts still 
remain irritated, and the patient does not recover as fast as he 
should. 

For chronic enlargement and induration: 

Baryt. carb. and mur., Calc. carb. and jod., Ignat., Lycop. 

Phosphor., mucus in throat removed with difficulty ; it is white, 
nearly transparent, in lumps and quite cold when it comes into 
the mouth. 

Phytol., enlarged tonsils and uvula ; tonsils of a bluish cast ; 
harrassing, hawking cough, after every cold. 

Psorin. and Sulphur. 

THE UVULA AND SOFT PALATE. 

These parts may be variously affected, being always more or 
less involved in diseases of the neighboring tissues. W~e have 
anaemia, hyperemia, haemorrhage, inflammation, oedema, ulcera- 
tion, phlegmon, thrush, diphtheritic exudations, atrophy, syphi- 
litic affections, morbid growths and cancer presented to our ob- 
servation, and also motor and sensory disturbances. 

Paralysis may be limited to the muscles of the soft palate, or 
may occur with paralysis of other muscles, most frequently those 
supplied by the facial nerve, or in connection with catarrh, 
phlegmonous inflammation, morbid growths, etc.. and in conse- 
quence of diphtheritis, the most frequent form. Its various forms 
interfere more or less with swallowing, talking and breathing. 



ANGINA FAUCIUM. 281 

Anesthesia of the soft palate, mostly with diminished reflex ir- 
ritability, is found in insane patients, and also in consequence of 
the influence of some substances upon the periphery (ice, bro- 
mide of potassium, morphine, lye, etc.). Diphtheritic paralysis 
is almost always combined with anaesthesia. 

Hyperesthesia occurs as well with the maintenance of a nor- 
mal appearance of the parts, as in the various disturbances of 
circulation and the inflammations. 

What in common life is styled "falling of the palate" is an in- 
flammation and (Edema of the uvula, by which it becomes greatly 
enlarged, causing a constant hacking 'and hemming, and inter- 
fering with swallowing and breathing. 

THERAPEUTIC HINTS.— The remedies which act especially upon 
the uvula and soft palate, are: Aeon., Argent., Bellad., Coffea, 
Grot, tigl., Gelsem., Hepar., Ignat., Iodium, Kali bichr., Laches., 
Merc, sol, Merc, subl., Natr. mur., Nitr. ac, Nux vom., Phosphor., 
Phytol., Sulphur. 

Angina Faucium, Angina Catarrhalis, Sore Throat. 

This catarrhal affection frequently involves the mucous mem- 
brane which covers the soft palate, tonsils and back part of the 
throat (fauces). The parts redden and swell, are at first dry and 
afterwards covered w T ith a whitish tough phlegm, which espe- 
cially assumes to a certain degree on the tonsils an appearance of 
diphtheritis. In its acute form it is mostly attended with some 
fever, painful deglutition, a heavily coated tongue, bad taste and 
an increase of saliva. Deglutition in bad cases, where the pala- 
tine and pharyngeal muscles are involved, becomes utterly im- 
possible, so that an attempt at swallowing causes either choking 
or an expulsion of the fluid through the nose. For this reason, 
also, the voice of the patient assumes a nasal twang in talking. 
Sometimes the inflammation extends higher up into the naso- 
pharyngeal cavity, affecting the Eustachian tubes and causing 
hardness of hearing and stitch-pain in the ears. 

It is caused either by atmospheric influences and a consti- 
tutional disposition '(idiopathic form), or is part and portion of 
certain acute diseases, such as scarlet fever, small-pox, measles, 
etc. (symptomatic form). At times angina faucium prevails epi- 
demically. 



282 FAUCES. 

THERAPEUTIC HINTS.— Aeon., dryness with burning, stinging 
and drawing in the throat, making swallowing painful, feverish- 
ness, impatience and restlessness. Cold west and north-west 
winds. 

Apis, burning, stinging pain, or pressing as from a hard body; 
redness and swelling of tonsils, uvula and tongue; abundant 
collection of soapy saliva; painful deglutition or impossibility to 
swallow. 

Bellad., scarlet redness; stitches extend into the ear; painful de- 
glutition or impossibility to swallow, the fluid escaping through 
the nose; swelling of cervical glands; red face; congestion to the 
head; headache; fever. 

Bryon., gastric derangement; tongue heavily coated, dirty yel- 
lowish; insipid, pappy taste; constipation; chilliness; motion in- 
creases the pain; irritableness. 

Ignat, lump in throat ; pain in throat worse between the acts 
of swallowing; whitish tough mucus in spots on tonsils, simulat- 
ing diphtheria. 

Laches., throat feels constricted; lump in throat; constant de- 
sire to swallow, though difficult and painful ; neck sore to touch ; 
all symptoms worse on left side, in the morning after sleep, and 
in the afternoon. 

Merc, sol., redness and swelling of the parts; whitish, smeary 
concretions on tonsils; tongue thickly coated, whitish; flow of 
slime and saliva from mouth; constant inclination to swallow; 
pain in parotid glands and muscles of the neck. Fever exacer- 
bation in the evening. 

Merc. corr. subl., when there is no swelling of the tonsils. Very 
often subdues the inflammation quickly when given at the com- 
mencement. (Bolle.) 

Nux vom., catarrh in head and throat, with a feeling of soreness, 
rawness, scraping and the sensation of a lump in throat on swal- 
lowing; after taking cold. 

Petrol., feeling of great dryness in the throat, with abundant 
accumulation of mucus at the same time. Stinging, burning 
pain in throat during deglutition, extending into the ears and 
neck. Great thirst and costiveness. 

Pulsat, dark, bluish redness with varicose veins, scraping raw- 
ness and dryness in throat, without thirst. 

Sanguin., throat feels sore and as if scalded by hot drinks ; dry 
and constricted; drinking does not relieve the dryness; mucous 
membrane feels as if it Avould crack, is red and inflamed. 



ANGINA FAUCIUM. 283 

Chronic Sore Throat, Angina Granulosa or Follicularis. 

It is characterized by little, roundish, elevated spots, like peas 
split in half, which stand either singly, scattered over the pha- 
ryngeal wall of the fauces, or in rows or ridges extending from 
above downwards; or the mucous membrane of that locality 
appears smooth, but dry and glistening; or it is covered with a 
tough whitish or yellowish-greenish mucus, or brownish and 
bloody crusts or skinny substance, which is very difficult to de- 
tach. In these cases the catarrhal affection extends up into the 
naso-pharyngeal cavity, and is mostly connected with chronic 
nasal catarrh; but it also may spread downwards to the larynx, 
where its presence causes laryngeal irritation and cough. The 
color of the fauces varies from a bright redness with enlarged 
veins radiating in various directions, to a deep brown red hue; 
in still other cases there is very little redness. Usually it is at- 
tended with very little pain, perhaps some raw feeling or scrap- 
ing, and with scarcely any difficulty in swallowing. The great 
annoyance of the patient is a feeling of dryness and the accumu- 
lation of tough phlegm which he constantly tries to remove by 
hemming and hawking, especially in the morning. In conse- 
quence of these, sometimes very violent efforts of cleansing the 
throat, small blood-vessels burst, which may unnecessarily alarm 
the patient, when he finds himself spitting blood. It is a very 
stubborn complaint and exercises a depressing influence upon 
the patient, who is kept in constant fear of going into con- 
sumption. 

This kind of chronic catarrh is frequently found with public 
speakers, clergymen and the like, wherefore it has received the 
popular name of preacher's sore throat, an appellation which, like 
many popular definitions, is not altogether well defined. For 
although the so-called preacher's sore throat in many cases may 
be attended with a chronic catarrh of the fauces, the sudden giv- 
ing out of the voice, or hoarseness after loud and forced speak- 
ing, is mainly the effect of overstraining the muscles of the soft 
palate or vocal cords. 

THERAPEUTIC HINTS.— Alum., soreness, rawness, hoarseness, dry- 
ness, or secretion of thick, tough phlegm; worse in the afternoon 
and evening, better from eating and drinking warm things. 

Arum triph., constant hawking ; profuse secretion from posterior 
nares and fauces; hoarseness, worse from talking. 



284 FAUCES. 

Arg. nitr., collection of thick, tough phlegm, causing gagging; 
wart-like excrescences ; feeling of a pointed bodj T in the throat 
when swallowing, belching, breathing, or moving the neck. 

Arnica, great hoarseness from preaching or public speaking. 

Caustic, burning in throat, worse on stooping ; hoarseness from 
singing. 

Elaps, sore throat, offensive discharge from the nose, occasional 
epistaxis. Posterior wall of throat covered with a dry, greenish- 
yellow membrane, wrinkled and fissured, which extends to the 
nares. Occasionally portions of it become detached and are ex- 
pelled either by mouth or nose. Stuffiness at root of nose and 
dull aching from there to forehead. Smell gone. Catamenia 
generally profuse and dark. 

Kali bichr., secretion of very ropy or stringy phlegm through 
the posterior nares and fauces. 

Laches., much inclination to swallow, although it is very pain- 
ful, with spasmodic contraction of the throat; worse on left side, 
and worse after sleep; can't bear any pressure about the neck. 

Lycop., the fauces look brown-red ; worse on right side ; some- 
times a hard, green-yellowish phlegm is hawked up in the 
morning. 

Natr. carb., slight redness and continual sensation of rawness 
and scraping; diminished secretion, with constant desire to hawk 
and hem; collection of mucus in the night; painfullness of throat 
on swallowing and gaping. 

Natr. mur., always after local applications of nitrate of silver; 
feeling of great dryness in the throat, and yet a constant hawk- 
ing up of a transparent, thin mucus. Sensation of a plug in the 
throat; uvula elongated; the action of the muscles of deglutition 
is diminished; the food goes the wrong way, or does not go down 
at all. 

Petrol., in dry, sore throat, with mucous secretions; stitches 
into the ears during deglutition, and burning in the neck. 

Phosphor., when the throat is ver}' dry, fairly glistening. 

Plumbum, when the disease spreads from left to right. 

Phytol., dryness, feeling as if a ball of red-hot iron had lodged 
in the fauces, when swallowing; can't eat hot fluids; choking 
sensation. 

Sapo sodse, after burning the throat by swallowing hot things. 

The following hints in the form of a repertory have been pre- 
pared by Dr. F. M. Selfridge : 



ANGINA FAUCIUM. 285 

Uvula and fauces dark red, Arg. nitr. 

Uvula elongated, Bromium, Wyethia. 

Swelling and elongation of the uvula, Iodium, Kali hydr. 

Uvula relaxed, with a sense of a plug in the throat, not re- 
lieved by swallowing, Kali bich., Laches. 

Uvula elongated, fauces purple and swollen, Laches., 

Thick, tenacious mucus, obliging him to hawk, Arg. nitr. and 
Merc, iod.; mucus cannot be raised by hawking, Caustic; mucus 
in fauces and posterior part of the pharynx, mornings, difficult 
to hawk up, Kali carb. 

Rawness, soreness and scraping in the throat, Arg. nitr., Caustic. 

Wart-like excrescences in the throat, feel like pointed bodies 
when swallowing, Arg. nitr. 

Posterior wall of pharynx dark red, glossy, puffed, showing 
pale red vessels, Kali bich. 

Burning and dryness of fauces and pharynx, Arg. nitr., Sanguin., 
Wyethia. 

Burning in pharynx, extending to stomach, Kali bichr., Wyethia, 
Sanguin. 

Dryness of roof of mouth, fauces and throat, Bellad., Wyethia. 

Throat feels raw and sore, looks red and shining, Bellad., Sanguin. 

Throat feels constricted, as if tied, Laches, or Iodium. 

Dryness of the throat posteriorly, Caustic, Wyethia. 

Constant hemming to clear the throat, Wyethia; of tough 
phlegm, Iodium. 

Must swallow continually, feels as if the throat was too narrow, 
Caustic 

Must swallow on account of the dryness of the throat, yet with- 
out affording relief, Wyethia. 

Throat dry with frequent empty sw T allowing, Mercur., Iodium, 
Wyethia. 

Salivary glands much swollen, Mercur., Iodium. 

Constant urging and desire to swallow, Bellad. 

Increased flow of tough, ropy saliva, Wyethia. 

Dryness in the posterior nares, Wyethia. 

Sensation as if something was in the nasal passages ; an effort 
to clear them through the throat affords no relief, Wyethia. 

Difficult deglutition, Bellad., Wyethia. 

Swelling of mucous membrane of fauces and pharynx, Bromium, 
Wyethia. 

Mucous follicles swollen, giving a granular appearance to 
pharynx, Wyethia. (Clinical). 



286 FAUCES. 

Tonsils swollen and inflamed, Bromium. 

Inflammation of the throat with burning pain, Iodium. 

Ulcers on fauces discharging cheesy lumps of offensive smell, 
Kali bichr. 

Hawking of mucus with pain in throat pit, Caustic. 

Hawks copious blue mucus in the morning, Kali bichr. 

Dry cough with tickling in the larynx, Bellad. ; in the throat- 
pit, Sanguin. ; large quantities of mucus, Iodium. 

Paroxysms of cough, brought on by phlegm in the larynx, Kali 
carb. ; by fits of passion or laughing, Arg. nitr. 

Cough with copious green sputa, Kali hydr. 

Cough with involuntary discharge of urine, Caustic. 

Internal soreness of larynx and throat-pit, worse in morning, 
Arg. nitr. 

Internal soreness of larynx, painful to touch, Bromium. 

Hoarseness, Arg. nitr., Bellad., Bromium, Kali bichr. 

Hoarseness with rawness and dryness of larynx, Laches. 

Hoarseness, worse in morning and evening, Caustic. 

Hoarseness lasting all day, Iodium. 

Hoarseness with pain in chest, Kali hydr. 

Chronic laryngitis of singers, raising the voice causes coughing, 
Arg. nitr. 

Dry hacking cough caused by tickling of epiglottis, Wyethia and 
Bellad. 

Ulcers in the Fauces, Ulcerated Sore-Throat. 

Chronic catarrh may terminate in ulceration ; or the ulcers 
may be the consequence of a scrofulous diathesis; or they may 
have a syphilitic origin. The diagnosis of these different con- 
ditions might be accurately determined by a correct history. 
Besides, the diagnosis will be facilitated by considering that 
catarrhal ulcers are superficial ; the scrofulous ulcer is deep, but has 
flabby, perhaps jagged edges, which do not project; the syphilitic 
ulcer, however, is deep and rounded, with elevated serpiginous 
and defined borders. 

THERAPEUTIC HINTS.— Compare Angina Faucium. 

Alum., the inflamed parts are spongy; the ulcerated surface 
secretes a yellow-brownish, badly-smelling pus; a boring pain 
from the fauces to the right temple and head. 



RETROPHARYNGEAL ABSCESS. 287 

Aurum, putrid, chcesc-like smell from the mouth ; deep ulcers 
affecting the bones ; after the abuse of mercury. 

Baptis., putrid, dark-looking ulcers ; fetid breath ; great pros- 
tration. 

Hepar, after the abuse of mercury in syphilis. 

Hydrast, extensively used by western Homoeopathic physicians 
for ulcerated sore-throat ; no characteristics given. 

Kali bichr., deep ulcers, eating even through the velum palati ; 
bones of the nose affected ; fetid discharge from the nose ; syphi- 
litic origin. 

Kali hydr., syphilitic and mercurial cachexia combined. 

Laches., spasmodic contraction of the fauces when swallowing, 
etc. Compare Inflammation of Fauces. 

Mercur., ptyalism, fetid smell ; secondary syphilis. 

Nitr. ac, after the abuse of mercury; syphilis. 

Sanguin., rush of blood to the head ; flying heat ; throbbing in 
the head from the nape upwards ; distended veins in the temples. 

Hetro-pharyngeal Abscess. 

This affection is either an acute suppuration of the connective 
tissue between the posterior wall of the fauces and the vertebrse, 
occurring not unfrequently in children up to the tenth year of 
age, or it is the consequence of diseases of the cervical vertebrae, such 
as caries, fracture, especially of the atlas and axis. Acute sup- 
puration of the retro-pharyngeal connective tissue usually takes 
a rapid course and develops symptoms like phlegmonous sore 
throat, in varying degrees of intensity, such as: fever, sleepless- 
ness, dyspnoea, difficulty in deglutition, pain increased on motion 
of the head, stiffness in holding the head, spasms in young chil- 
dren, and convulsive paroxysms. 

Suppuration from vertebral affections is much slower in its 
course and its symptoms are less prominent, with the exception 
of an inability to turn the head, and the difficulty of swallowing. 

The abscess, left to itself, opens spontaneously and discharges 
its contents into the lower pharynx ; or fistulous tracks are 
formed towards the thoracic cavity, or towards the skin of the 
neck. 

A fatal termination may ensue by suffocation from the dis- 
charge into the larynx, especially during sleep ; or from com- 
pression of the larynx by the enormous size of the tumor; or 



288 FAUCES. 

from secondary disease of the larynx or thoracic organs caused 
by descent of pus into the thorax. These various possibilities 
determine our prognosis. 

Its Diagnosis we can make out by inspection and palpation, as 
its location (posterior wall of fauces) distinguishes it from amyg- 
dalitis ; or the symptoms of vertebral affections render it at once 
distinguishable from other complaints. 

THERAPEUTIC HINTS.— Main remedies : Hepar, Silie. 

Acute suppuration of the connective tissue: Apis, Bellad., 
Bryon., Laches., Mercur., Pulsat., Rhus tox. 

Affection of cervical vertebrae : Arnica, Asaf., Calc. carb., Hepar, 
Lycop., Mercur., Mezer., Phosphor., Silic, Sulphur. 

Impossibility to swallow ; fluids regurgitate through the nose : 
Aurum, Bellad., Laches., Lycop., Mercur., Nitr. ac, Phosphor. 

Deep Inflammation of the Connective Tissue of the 
Throat ; Angina Ludovici. 

"It is a very acute inflammation and suppuration of the cellu- 
lar tissue beneath the chin, in the environs of the submaxillary 
glands, which has been named after its earliest describer, " Lud- 
wig," and which has appeared epidemically at various times." 

The inflammation generally begins on one or the other side of 
the hyoid bone, rarely in the middle, just over the bone. There 
is extensive infiltration with disposition to undergo purulent or 
even ichorous degeneration. Post-mortems have shown the con- 
nective tissue and muscles of the entire submental region trans- 
formed into a semi-fluid, brownish mass, mixed with necrotic 
shreds of connective tissue ; the submaxillary and parotid glands 
destroyed by gangrene; the neighboring parts intensely infil- 
trated even as far as the pharynx and larynx ; and the perios- 
teum of the lower jaw loosened. 

The swelling in the hyoid region sets in with lighter or severer, 
or even complete typhous symptoms; it grows rapidly, gets harder 
and larger until it covers the entire anterior half of the throat as 
far down as the sternum. 

The skin over it is tightly stretched and reddened ; the lower 
jaw becomes immovable and deglutition impossible. Respira- 
tion and circulation are greatly interfered with by compression 
of the larynx, trachea and the main internal jugular vein, and 



THRUSH. 289 

speech is made difficult or impossible by the pressure of the tu- 
mor under the tongue, which pushes it to the roof of the mouth 
and renders it immovable. It is attended with headache, ver- 
tigo, delirium. 

In some cases the swelling may entirely subside without sup- 
puration, although absorption goes on but slowly; in most cases 
suppuration sets in and the result is a shreddy pus, or a gangren- 
ous ichor, with subsequent gangrenous destruction, septicaemia, 
embolism in various organs, death ; or in more favorable cases 
fistulous ulcerations, strongly contracting cicatrices, which pro- 
duce torticollis and impeded mobility of the neck, as also caries 
and necrosis of the jaw-bones. 

Its Causes are said to be : topical irritations, catching cold, 
especially during times of prevalent rheumatism and erysipelas ; 
and exanthematic, typhoid and puerperal conditions. Of late no 
epidemics of this kind have been observed. 

THERAPEUTIC HINTS.— I find only one case mentioned in our 
literature, by Dr. J. C. Burnett, which was cured by Aeon., and 
Iodium, and later Nux vom. and Iodium, in alternation. Compare 
Raue's Annual Record, 1874, page 108. 

1 should suppose that Anthrac. and Laches, might be of great 
service in this destructive disease. 



THE MUCOUS MEMBRANE OF THE MOUTH IN 
GENERAL. 

This is a continuous membrane covering the inside of the 
clteeks and all the organs within the cavity of the mouth except 
the teeth, lining the fauces, and extending thence upwards into 
the nose and downwards into the oesophagus, stomach, and in- 
testines, and by way of the larynx and trachea into the finest 
bronchial tubes. 

The Parasitic Sore Mouth of Infants— Thrush. 

"It is neither connected with inflammation, nor with the for- 
mation of ulcers, but depends upon the abundant development 
of a microscopic fungus, the oidium albicans (Robin), which com- 
bines with the epithelium into thick, white membranes, and 
covers a great portion of the surface of the mouth." (Vogel.) 
19 



290 MUCOUS MEMBRANE OF MOUTH. 

We may frequently foretell its coming, when we observe that 
the mouth of the infant is getting dry, hot, red and sticky and 
its secretion gives an acid reaction. Then after a few hours white 
points of the size of a pin's head appear mostly at first on the 
inner surface of the cheeks, quickly spreading over various other 
places and soon covering in some cases the entire buccal cavity, 
and even the pharynx and oesophagus with a white membrane. 
After a while its white color turns yellowish or brown if bleeding 
occurs from rough handling. The first few days this membrane 
adheres firmly to the mucous membrane; later, on about the third 
or fourth day it becomes loose and can easily be wiped away. 

According to Reubold this fungus confines itself to the squamous 
epithelium solely, and therefore the larynx, trachea, and the nasal 
cavities, the stomach and intestines remain free from it. It has 
been found, however, on the lowest portions of the rectum, upon 
the female genitals, and excoriations of the external skin, es- 
pecially in the vicinity of the mouth, on the chin and neck. 

During the continuance of this fungous groAvth the mouth of the 
nursling is hot, has an acid reaction and is sensitive to touch in 
a degree that even nursing sometimes is painful to the child. 
But as long, as the affection is not complicated with intestinal 
catarrh, its course is quite mild and short, and passes away in 
a few days if proper attention is paid to cleanliness. Even if a 
reproduction should occur, it offers no special difficulty to cleans- 
ing and leaves the substance of the mucous membrane intact. 

It is different with artificially fed children when an intestinal 
catarrh is superadded to the trouble. Under it the child may 
sink with signs of a follicular enteritis. 

Causes. — The formation of this fungus is favored by acid fer- 
mentation. The secretion of the mouth is a mixture of saliva 
and mucus. The saliva is of alkaline reaction, more so after a 
meal, less so on an empty stomach. The buccal mucus, however, 
has an acid action, which is visibly increased on contact with 
atmospheric air, when acid fermentation at once begins. In 
young infants the secretion of mucus is in preponderance over 
the secretion of saliva; there is therefore a physiological tendency 
to acidity in a young child, and if in addition to it, the child is 
nourished artificially and improperly by substances which easily 
undergo acid fermentation, (sucking-bags, poor milk from badly 
cleansed bottles, etc.) an outbreak of thrush is sure to follow. 
We find, therefore, that thrush attacks more frequently arti- 



STOMATITIS ULCEROSA. 291 

ficially fed children than those who suck their mother's breast, 
and for this additional reason that the latter in sucking draw the 
saliva out of their salivary glands, while the easy flow from the 
bottle requires nothing but swallowing. I would rather have 
the baby fed by the spoon, as in this way chewing motions are 
induced and a more thorough mixture of the food with saliva is 
insured. 

We find thrush also in adults, but it is of rare occurrence, and 
then always in consequence of protracted and exhausting dis- 
eases, such as phthisis, diabetes, cancer, etc. — setting in shortly 
before death. Its pathological character is identical with that 
described above, and its causes are the same — anomalies in the 
chemical composition of the fluids of the mouth, accelerated acid 
fermentation and absence of the movements of chewing. 

THERAPEUTIC HINTS.— The remedy must be chosen according 
to existing symptoms which accompany this affection. 

Wash the mouth always after nursing with a rag dipped in 
water or a mixture of wine and water. 

Aethusa, vomiting of milk in lumps ; diarrhoea. 

Arsen., in adults and children ; great burning, exhaustion, deep 
illness. 

Baptis., last stage of consumption. 

Borax, great heat and dryness in the mouth. 

Chamom., child is fretful, wants to be carried about all the time ; 
has colic, and green, sour stools. 

Hepar, when worse on inside of lower lip. 

Mercur., confluent thrush, changing into cankers ; ptyalism ; bad 
smell from the mouth; feverishness; green slimy stools. 

Staphis., thrush changing into canker-sores with a bluish-red or 
yellowish bottom ; more or less flow of saliva and bad smell. 

Sulphur, sour smell from the mouth ; stools slimy with much 
straining, or painless ; worse in the morning. 

Sulph. ac, after borax, increased flow of saliva, yellowish color 
of the skin. 



Stomatitis Ulcerosa; Formation of Ulcers in the Cavity 
of the Mouth. 

The mucous membrane of the mouth is subject to catarrhal in- 
flammations. When in addition to congestion, swelling, pain, 



292 MUCOUS MEMBRANE OF MOUTH. 

and increased secretion, a loss of substance associates at any 
point, we have Ulcerous stomatitis. Its forms are various. 

Aphthae, or Cankers of the mouth. They are either the conse- 
quence of Catarrhal erosions, forming ulcers of a superficial nature; 
or of Follicular inflammation, producing ulcers of greater depth ; or 
in connection with Labial herpes or Hydroa, when they evidently 
have the same etiological significance. Aphtha? occur chiefly in 
children. The follicular form is frequently found in women dur- 
ing menstruation, pregnancy or lactation. Often a few hours are 
sufficient to bring about aphthous ulcers. They are chiefly -situ- 
ated on the mucous membrane of the lips and cheeks; especially 
where it is reflected on the gums, less frequently on the gums 
themselves, on the palate, or on the tongue. Their floor is 
whitish, yellow, their edges are reddened, somewhat raised, on 
account of the adjoining catarrhal stomatitis; they are of an 
oval form and may attain the size of a bean. The follicular 
ulcers are small, circular and excavated. All cause great sensi- 
tiveness of the mouth, interfere materially with speaking and 
chewing, and are attended with an increased secretion of mucus 
and saliva, which, however, is not marked by any great intensity 
of nauseous odor, as we always find in Stomacace, or Putrid sore 
mouth, which is a destructive ulceration of the border of the 
gums, producing extensive swelling of the entire mouth and a 
cadaveric breath. It is mainly a disease of children, after their 
first dentition has been completed, but not found very frequent 
in private practice. Apart from children it has appeared epi- 
demically among soldiers. Very often, when it appears sporadi- 
cally, its cause can be traced to the abuse of mercury, or an en- 
feebled state of the system, uncleanliness, poor food, and atmos- 
pheric influences. The morbid process usually begins at the 
margin, of the gums of the lower jaw, creeps gradually back- 
wards, and attacks somewhat later those portions of the mucous 
membrane of the lips, cheeks, and tongue, which are in direct 
contact with the affected gums. The surface of the tongue, the 
hard and soft palate, as well as the pharynx, remain free from it. 
It is characteristically marked by great fetor, and a profuse, dis- 
tinctly acrid secretion, flowing constantly from the mouth. On 
pressure the gums bleed easily, or bleed spontaneously, coloring 
the saliva brownish-red. The tongue is thickly coated and 
swollen, showing distinct impressions of the teeth. The adjacent 
lymphatic glands are also tumefied. The fever attending it is 
ordinarily but slight. 



STOMATITIS ULCEROSA. 293 

Ulcers dependant on some dyscrasia, such as syphilis, scorbutus, 
etc., will be spoken of in their respective places. 

THERAPEUTIC HINTS.— Aphtha 

Arum, triph., superficial ulceration; tumefaction of lips; catar- 
rhal burning and biting sensation in mouth and throat. 

Calc. carb., during dentition. 

Hydrasi, follicular and catarrhal ulcers with exceedingly tena- 
cious mucus in the mouth. 

Laches., canker sores on tip of tongue. 

Lycop., under the tongue near the frsenulum. 

Mercur., on the gums, with ptyalism. 

Natr. mur., on tongue, gums and cheeks with great burning and 
impeded speech. 

Nux vom., gums inflamed, putrid smell from mouth; con- 
stipation. 

Sulphur, after Xux vom. or Mercur.; bloody saliva; disturbed 
sleep. 

Sulph. ac, on gums which bleed readily; ptyalism; great weak- 
ness; ecclwmosed spots on skin. 

Stomacace. 

Arsen., edges of tongue ulcerated with great burning and pain ; 
diarrhoea and great prostration. 

Baptis., gums ulcerated, loose, dark red or purple; intolerable 
fetid breath; can swallow only liquids; loose, offensive stools; 
after abuse of mercury. 

HeUeb., sores flat, yellowish, with raised edges upon an inflamed 
basis; ptyalism; fetid smell from the mouth; glands swollen on 
neck and under the jaw. 

Hepar, after abuse of mercury. 

Kali mur., main remedy of the old school. 

Mercur., ulcerated gums, tongue and cheeks; loose teeth; fetid 
smell. Burning pain, worse in night; diarrhoea with tenesmus. 
In fact it is proven to have produced this disease in its worst 
forms; it must, therefore, in many idiopathic cases, be almost 
specifically indicated. 

Nitr. ac, after the abuse of mercury with fetid and acrid saliva, 
which causes sores on lips, chin and cheeks. Pustules with red 
circumference, here and there on body. 

Nux vom., ulcerated gums, foul and painful swelling of gums; 
pimples and painful blisters in the mouth; ptyalism at night, 
bloody saliva; fetid odor from mouth; constipation. 



294 MUCOUS MEMBRANE OF MOUTH. 

Phytol., edges of tongue ulcerated, tip very red; secretion of 
mouth very thick and tenacious. Mercurial ptyalism. 

Rhus tox., great restlessness, especially in the night; bloody 
saliva runs out of the mouth. 

Staphis., ulcers with a bluish-red or yellowish bottom ; gums 
swollen, painful, spongy, bleeding readily; increased bloody 
saliva ; fetid breath. 

Sulphur, gums ulcerated, swollen, receding and readily bleed- 
ing; bloody saliva; fetor; diarrhoea; sleeplessness. Frequently 
indicated after Nux vom. 



Diphtheria, Diphtheritis. 

A disease of miasmatic-contagious nature. The latest experi- 
menters (Oertel, Klebs and many more), ascribe it to the action 
of parasitic fungi or bacteria, the micrococcus diphtheriticus, "while 
others (Wagner, etc.), still content that its specific poison is en- 
tirely unknown. I shall not waste time to give a history of these 
two theories, since special expositions of both views have been 
given in Vols. I. and II. of Ziemssen's Cyclopaedia and other 
works. 

Diphtheria may localize itself in different organs. 

1. In the throat, at times spreading to the upper pharyngeal 
and nasal cavities, into the Eustachian tubes and lachrymal 
ducts. It produces a fibrinous exudation which first appears 
on one of the tonsils, seldom simultaneously on both, in the 
form of roundish, dead white patches of various sizes, at the 
beginning closely adherent to the underlying mucous membrane 
and detachable, for the most part, only at the expense of a haem- 
orrhage. As they grow, they cover larger and larger areas, 
finally enveloping the tonsils, uvula, and the walls of the pha- 
ryngeal cavity in one sheet of false membrane. This membrane, 
after a continuance of several days, becomes gray, even blackish, 
and less adherent to the subjacent tissue; it consists of fibrinous 
exudation, the interspaces of which contain serum, or blood or 
pus corpuscles. " Not unfrequently globular bodies, which con- 
sist of finely punctated masses of fungus, are found in one or 
more layers, upon the surface of the croup membrane, and later 
in spots between the uppermost flattened layer of epithelium and 
the croupous reticulum." (Wagner.) According to Oertel. the 
colonies of micrococcus penetrate to the subepithelial tissue. 



DIPHTHERIA, DIPHTHERITIS. 295 

After several days continuance, the false membrane loosens 
by means of infiltration with serum or pus corpuscles, and a 
continual growth of new epithelium. The mucous membrane 
underneath is hyperaunic, sometimes dotted with variously nu- 
merous haemorrhages, for the most part considerably infiltrated 
with scrum, sometimes with sero-pus. In septic cases the false 
membrane undergoes a rapid necrosis, and proportionally with 
its decomposition and putrefaction, large quantities of different 
varieties of bacteria appear besides the micrococcus. The mem- 
brane assumes a dark brown color, and is infiltrated in broad 
streaks by blood corpuscles from frequent capillary haemorrhages. 
An extension into the nose is characterized by a thin, purulent, 
greenish discharge, which excoriates the contiguous parts of the 
external nose. 

2. In the larynx, trachea and bronchi. This forms a chief danger 
of diphtheria, and resembles in all its symptoms true croup. In 
a series of cases it sets in with the pharyngeal affection at the 
same time, in others it follows soon after, or develops not before 
three or four days, or even a week later. It occurs oftener in 
children than in adults, and much more frequently in severe 
than in mild cases. Its characteristic signs are the long drawn 
respiration, frequent, dry coughs, toneless, hoarse voice, great 
restlessness, and pain in the throat. 

3. In the kidneys, causing an inflammation of their paren- 
chyma, with haemorrhages and growths of micrococcus. (Oertel). 
At the bedside it manifests itself as albuminuria, which, when 
found in the beginning, is said to denote unusual severity of the 
attack. In fact its intensity is thought by some writers propor- 
tionate to the severity of the disease, which others deny. In 
light cases it scarcely ever occurs ; in severe cases it is found in 
one-half their number; it sets in sometimes not until several 
days, sometimes not until towards the termination of the disease, 
and is, as regards the quantity of albumen discharged, very ir- 
regularly, sometimes even intermitting for days. (Wagner.) 

4. In the heart, especially in long-continued and severe cases, 
which are apt to terminate suddenly in death by paralysis of the 
heart. On post-mortem examination the muscles of the heart 
appear pale, soft, friable, fatty degenerated. 

5. In the stomach., either by direct poisoning from swallowing 
the diphtheritic masses, or by an extension of the affection 
through the oesophagus into the stomach. It causes here, as it 



296 MUCOUS MEMBRANE OF MOUTH. 

does in the fauces, inflammation of the" mucous membrane, exu- 
dation of fibrine, formation of ulcers and sloughs, and haemorrhage. 

6. In the brain and in the spinal cord. Post-mortem examina- 
tions have shown venous hypcreemia in the vascular linings and 
substance of the brain and spinal cord, also capillary haemor- 
rhages of various sizes scattered over different portions of these 
organs, with consequent softening of the surrounding substance. 
Buhl found in one case the spinal nerves of both sides, at the 
point of junction of their anterior and posterior roots, almost 
, doubled in their thickness, and dark red on account of extrava- 
sation of blood, and in part yellow and softened. 

The period of Incubation occupies, according to a number of 
well-attested observations, from two to four or five days. 

Diphtheria is not in all cases of a like nature; we meet mild, 
severe and septic forms of this disease. 

Its mild forms, which, by some,, are designated as Catarrhal 
diphtheria, usually commence with fever and soreness in the 
throat. The temperature may rise from 101° to 105° F. in the 
first days, showing always evening exacerbations with a corre- 
sponding acceleration of the pulse from 120 to 140. From the fourth 
or sixth day the temperature gradually declines. The fauces 
look at the beginning only inflamed, but show in a short time 
the characteristic patches first on one tonsil, and then on the 
other, extending also in some cases upon the contiguous portions 
of the palatine arches, and in some upon the lateral portions of 
the uvula. With this we find the lymphatic glands of the jaw, 
regularly, somewhat swollen, a distinctive feature of diphtheria 
from a mere catarrhal inflammation of the throat. The fever is, 
in most instances, attended with more or less, sometimes exces- 
sive, languor and debility from the outset, with headache, pain in 
the back, also at times with gastric symptoms, seldom vomiting. 
The disease may not reach a higher degree, but terminate in 
from five to fourteen days in recovery; but there may take place 
from about the fourth to the sixth day, a sudden rise of fever, 
with a rapid spread of the false membrane in the fauces, when 
the disease has assumed one of 

Its severer forms, which some writers have designated as Croup- 
ous diphtheria. In some cases this grave character shows from 
the beginning, by the greater intensity of the symptoms above 
described. The false membrane rapidly gains in thickness and 
extent, spreading either upward through the pharynx into the 



DIPHTHERIA. DIPHTHERITIS. 297 

nasal cavities, affecting the Eustachian tuhes or the lachrymal 
ducts, or even the conjunctiva.', or downwards into the larynx, 
trachea and hronchi, or through the oesophagus into the stomach. 
Its color gradually turns to a dark brown or even blackish hue, 
in consequence of haemorrhage underneath and decomposition of 
its substance with a corresponding terrible stench. The cervical 
and submaxillary glands swell to a still greater extent; the urine 
becomes scanty, dark-colored and rich in salts and shows in at 
least one-half, if not in more cases, signs of albuminuria in dif- 
ferent degrees, often, though not always, nearly proportionate to 
the intensity of the disease. If the morbid process descends to 
the stomach, its functions become disturbed, there is loss of appe- 
tite, nausea, at times vomiting, and oftener constipation than 
diarrhoea. The affection of the heart ordinarily does not become 
apparent until at a later period, when there is not a trace left of 
diphtheritic appearance in the throat. But the patient remains 
weak, pale, without appetite, has frequent nausea and vomits all 
he eats. This symptom, whether it is derived directly from a diph- 
theritic condition of the stomach or by a mere reflex action from 
the brain, is, as far as my experience goes, always a very ominous 
sign; the patient usually dies with paralysis of the heart. 

The septic or gangrenous forms of diptheria are especially char- 
acterized by extensive disorganization of the tissues, by capillary 
haemorrhages on the surface of the mucous membrane and gen- 
eral blood-poisoning. One series of these malignant cases is de- 
veloped from the croupous form, while others, a less frequent series, 
begin to be gangrenous from the onset, especially in malignant 
epidemics. Its phases follow each other in quick succession. 
The false membranes form on a livid cedematous mucous mem- 
brane, and soon undergo ichorous disorganization ; the discharges 
from the mouth and nose become stinking and corroding; the 
cervical and submaxillary glands swell enormously, and there is 
oedema of the surrounding connective tissue. The face of the 
patient becomes bloated, pale, wax-like ; his pulse small, weak, 
irregular and sometimes remarkably slow; the temperature is 
occasionally high, as much as 107j° F., but usually it is dimin- 
ished. Not unfrequently death is preceded for a few minutes by 
convulsions, or it instantly follows the sudden raising of the 
patient; sometimes the evidences of collapse continue for several 
days. 

Diphtheria is often found in connection with Scarlatina, when 



298 MUCOUS MEMBRANE OF MOUTH. 

it may set in during the prodromal stage, sometimes during the 
height of the exanthem, less frequently after its disappearance, 
or even not till the end of the second week of the disease. It ex- 
hibits the same three forms as described above. It also has been 
found secondarily in typhoid fever, pyaemia, puerperal fever, ery- 
sipelas, whooping-cough, measles, and in chronic diseases, such 
as : tuberculosis of the lungs , extensive pleural exudations, 
chronic diseases of the kidneys (Bright's disease, so-called second 
and third stages), chronic suppurative inflammations of the 
joints, and chronic diseases of the liver, especially in topers. 

As Sequelae, we must mention especially different forms of 
paralyses, which may occur after any of the forms of diphtheria. 
"They appear most commonly two weeks, sometimes one week, 
occasionally three or four weeks, after the healing of the local 
processes, and in some cases not until after convalescence. They 
most frequently affect the soft palate and consist in paralysis of 
both motion and sensation ; less often they affect the extremities 
in like manner, with or without the paralysis of the soft palate ; 
sometimes they are all affected at the same time, or one after the 
other; preferably the lower extremities only; sometimes the 
sphincters also. Paralysis of the muscles of the eyes and of the 
larynx is more rare. Not unfrequently there are analogous con- 
ditions of the higher organs : either alone, or at the same time 
with the paralysis mentioned, most frequently of the organs of 
vision (presbyopia, myopia, even total blindness), more rarely of 
the organs of hearing, smell and taste. Sometimes there is im- 
potence. After a continuance of the paralysis for weeks or for 
months, complete recovery usually takes place — death but sel- 
dom." (Wagner.) According to the results of minute investiga- 
tions, these functional disturbances in the different muscles must 
be attributed partly to morbid alterations in the muscles them- 
selves (fatty degeneration), and partly to diseased conditions of 
the brain and spinal cord (see above). 

The Diagnosis of diphtheria is ordinarily not difficult, especi- 
ally not iii epidemics. But its mild forms might be mistaken for 
a catarrhal angina — compare the respective chapter — , were it 
not for the general symptoms and the peculiar appearance of the 
diphtheritic exudation, which differs essentially from a mere 
secretion of catarrhal angina, forced out of the follicles as a yel- 
lowish, sticky mass which easily may be wiped off by a brush, 
or from follicular erosions which show a distinct loss of sub- 



DIPHTHERIA, DIPHTHERITIS. 299 

stance at their borders, or from aphthae which commence as 
small vesicles and gradually form ulcers. The severer forms can 
hardly be confounded with other diseases. Simple croup has no 
affections of the glands and kidneys, and scarlatina — even if 
diphtheria should be accompanied, as it happens in rare cases, 
by a slight erythema of the neck and breast — has no formation 
of false membranes in the fauces. 

The Prognosis of diphtheria, generally speaking, under ho- 
moeopathic treatment, is not bad. Of course, we meet difficult 
cases, even fatal ones ; but the percentage of loss is small. Its 
danger lies principally in the possibility of its extension to the 
larynx, and its septic poisoning. 

THERAPEUTIC HINTS.— In looking over the homoeopathic liter- 
ature on this subject, leaving alone the allopathic, one feels al- 
most tempted to exclaim: "Lord, hold on with thy blessings!" 
as the parson said, when he received the news that a son had 
been born to him, and a little while after, a daughter, and still a 
little while later, another son ! Nevertheless they all were wel- 
come, and each one showed its own individual character, and 
got its own share of parental love. 

There is no specific remedy for diphtheria nor for any other so- 
called disease. 

Acids, especially organic acids, have proved themselves in vari- 
ous degrees capable of dissolving the diphtheritic membrane. 

Acet. ac. has not been given, to my knowledge, in diphtheria ; 
but it has been found by Dr. Krebs, in Hamburg, Pa., very effec- 
tive in croup. I can confirm his observations, especially when 
there is a bright redness of the face attending it. 

Carb. ac. has been the sheet-anker of Dr. Davidson, though it 
has by no means proved a universal remedy for diphtheria. Its 
indications are: low fever with great prostration, weak pulse and 
paleness of face; absence of severe inflammation and pain in the 
throat, but abundant formation of false membranes, with great 
danger of septic poisoning and great fcetor oris. 

Citr. ac. is recommended by Buchner, and thought better than 

Lact. ac. This latter has many throat symptoms, e. g., dryness 
and constriction similar to Laches.; difficulty of swallowing 
solids, etc. 

Mur. ac. has proved curatively when there were : bleeding from 
the nose/ the blood dark and putrid; sordes on the t^eth; sore 



300 MUCOUS MEMBRANE OF MOUTH., 

and scabby condition of the lips; putrid smell from the mouth; 
great general prostration; typhoid condition. 

Nitr. ac, ulcers in the mouth; great pain on swallowing; ex- 
cessive salivation; corroding discharge from the nose; fcetor oris; 
great uneasiness; high fever; intermitting pnlse. After over- 
dosing with mercury; syphilitic taint. 

Salycil. ac, when there is little or no fever, but great weakness, 
difficult deglutition, much inflammation, and the exudate soft. 
First centesimal dilution, a few drops in half a glass of water, 
one teaspoonful every half hour or hour, and the same as a 
gargle. (Oehme.) 

Sulph. ac. Oehme gives the following resume" : tonsils bright 
red and swollen; exudate thick, grayish, or yellowish-white, 
sticky tenacious; swallowing very difficult, liquids run out of the 
nose; swallowing almost impossible; breathing difficult on ac- 
count of the accumulation of the exudate; speech thick, indis- 
tinct, very difficult; violent salivation; excessive foetor oris; pulse 
frequently small, weak; apathy; somnolence. Excessive pale- 
ness and weakness. 

Ailanth., especially in scarlatinal diphtheria with livid and 
sw y ollen throat, and tonsils studded with numerous deep, angry- 
looking ulcerations. 

Alcohol, diluted with water, recommended by Von Grauvogl as 
a gargle and applied by some in the form of a spray, has proved 
to be not the homoeopathic remedy, but a most beheficient ad- 
juvant in the treatment of diphtheria, because of its antisq>tic 
properties, its stimulating effects upon the system and its non- 
interference with the homoeopathic remedy given at the. time. 
Instead of alcohol, brandy, whisky or rum may be used: 

Amm. carb., obstruction of the nose ; the moment he falls asleep 
he is aroused by the want of breath. 

Amm. canst, 15 drops to a glass of water, cured a case with 
croupous cough, which threatened suffocation every moment. 
The lower part of the pharynx covered with a white exudate, 
extending down as far as could be seen. Patient in the greatest 
agony, frequently jumping out of bed and gasping for breath. 
(Spranger.) Single observation. 

Apis mel., great debility from the beginning : puffiness around 
the eyes and cedematous swelling of face and neck ; bright red 
color, and puffy, glossy and varnished appearance of fauces ; 
uvula cedematous; stinging, burning pain in throat and" dryness; 



DIPHTHERIA, DIPHTHERITIS. 301 

pain in the ears when swallowing; difficult swallowing on account 
of irritation of the epiglottis; sensation as of a rapid swelling of 
the lining membrane of the air-passages; hoarse cough; intense 
sensation of suffocation, could bear nothing about the throat; 
labored inspiration as in croup; headache; painful, or suppressed 
micturition; albuminous urine; pain in shoulders and neck, 
darting, cutting, in periodical spells; itchy, stinging eruption on 
the skin ; sensation of weakness in the larynx ; weakness of feet 
and hands, even paralysis ; marked prostration and depression ; 
nervous restlessness; high fever. Combination with scarlatina. 

Arnica helps us in two conditions : 1. Where we meet rapid 
decline of strength, small and rapid pulse after a too rapid course 
of the inflammatory fever (but the presence of Bright's disease 
may cause Arsen. to be preferable). 2. After the infiltration had 
run its course, with tendency to necrotic ichorrhsemia, in lym- 
phatic persons subject to torpidity, with noisy deglutition, great 
debility, adynamia, excessive depression, and deep-seated coaffec- 
tion of the whole nervous system and the brain, in short, absence 
of all erethismus after expulsion of the exudations. Physiological 
symptoms are : General loss of strength ; heaviness and paresis 
of the right side, in contradistinction to Lachesis, and of the 
shoulder ; foul breath ; burning in the throat, with anguish from 
internal heat; stitching posteriorily, as if some hard substance 
were in the pharynx ; noisy and difficult deglutition, prevented 
by a kind of vomiturition, as if the food could not pass down- 
wards. (Buchner.) 

Arsen., in the later stages of the disease when there are: great 
restlessness, wants bed and room frequently changed; constant 
desire for cold drink, but taking little at a time, or better from 
drinking hot water; all symptoms worse after midnight. Albu- 
minuria; paralysis of lower extremities. 

Ars. jod., cured a case with asthmatic and croupy symptoms; 
hoarse cough ; diphtheritic deposit covering mouth from fauces 
to outer lips, also external auditory canal; pulse weak and slow; 
great prostration; bad odor from patient. (F. Bigelow.) 

Arum, triph., burning in the throat ; constant inclination to 
clear the throat of collections of mucus which increases the burn- 
ing and rawness; hemorrhage from nose (M. Preston); the dis- 
charges from the nose and mouth are very acrid, and excoriate 
the skin wherever they come in contact with it; the lips are sore 
and swollen, and the skin peels off; the patient continually picks 



302 MUCOUS MEMBRANE OP MOUTH. 

at his lips and nose, making them bleed. Drink is refused on 
account of the great soreness of the mouth; the breath is very 
fetid, and the cavity of the mouth covered with diphtheritic 
deposits and ulcers; great restlessness, the patient crying and 
throwing himself about into all sorts of positions. (Lippe.) 

Baptis., characterized by absence of pain, although the fauces 
and posterior nares are oedematously swollen with constant incli- 
nation to swallow. Stupefaction and drowsiness; mind wander- 
ing; low muttering. Oppressed breathing unto suffocation on 
account of pulmonary congestion. Rising in bed does not relieve ; 
the patient must go to the window for fresh air. Stools dark and 
blood-streaked. 

Bellad., in sudden attacks with fear of choking to death; great 
dryness and redness of the throat and great pain on swallowing. 
External swelling of the neck. High fever; great drowsiness 
with inability to fall asleep ; starting in sleep. Suitable only at 
the beginning. 

Bromium, Ozanan's favorite remedy. Is indicated by a hoarse, 
croupy cough with rattling in the larynx. 

Bryon., the patient is quickly prostrated, shuns all motion, and 
complains, on moving or when being moved, of pain everywhere; 
white tongue; feeling of dryness in the mouth without thirst, or 
else desire for large quantities of water. Only in the beginning. 

Calc. chlor., recommended and used by Dr. 0. Xeidhard. 

Canthar., burning and scraping in the throat with bloody ex- 
pectoration; too copious, or scanty and difficult urination; the 
urine contains casts of the uriniferous tubuli; also albumen; 
extreme prostration; sinking, death-like turns; irritable rash 
upon the skin or showing through the epidermis. 

Gelsem., local tingling of parts during the fever ; incipient pa- 
ralysis or anaesthesia; defective or impaired vision; objects ap- 
pear a long way off, are seen double or inverted. 

Ignat. The honor of having first introduced this remedy for 
the treatment of diphtheria belongs to Dr. Boskowitz, of Brook- 
lyn. I have given it for several years with the most marked 
effects, and so have several of my colleagues to whom I have re- 
commended it. During an epidemic in Lehigh county, Pa., Dr. 
Wm. C. J. Slough did not lose a single case after he commenced 
using Ignat., 200th trit., persistently a teaspoonful every hour or 
two, in spite of delirium, haemorrhage or other untoward symp- 
toms. That epidemic was characterized by the following symp- 



DIPHTHERIA, DIPHTHKKITIS. 303 

toms: "green vomiting; putrid throat, seldom painful (the pain- 
ful eases were less likely to prove fatal); greenish-yellow patches; 
delirium ; headache ; green stools ; suppression of urine ; some- 
times chilliness; sometimes high fever." I must confess I have 
not yet found any particular indications for this remedy ; it 
acted well in all cases. Whether this be attributable to the ge- 
nius epidemicus in this region of the globe is possible. If so, it 
will lose its efficiency when that changes. But there is no doubt 
that the provings of this drug present numerous hints for its 
application. 

Iodium, probably useful like Bromium in affections of the larynx. 

Kali bichr., the discharge from the nose is tough and stringy ; 
pain in left ear on swallowing; swelling of the parotid glands; 
croupy cough; measle-like eruption; red, raw, shining tongue; 
or also covered with a thick yellow coating ; deep-seated ulcera- 
tion in the fauces ; mucus streaked with blood. 

Kali mur., sufficient in most cases; but when soft parts of the 
fauces are much swollen: Calc. sulph. (Sch ussier). 

Kali phosph., in malignant cases; offensive odor. (Schiissler). 

Kreosoi, in malignant cases confined to the fauces with terrible 
fcetor oris. 

Lac can. The following proving by Dr. H. W. Taylor, is very 
suggestive: " Rolled and tossed about all night; could not sleep 
on account of uncontrollable feeling of restlessness; necessity to 
turn and shift about constantly. Palms of hands and soles of 
feet abnormally hot ; sighing frequently ; utter inability to lie 
half a minute in one position. Throat feels dry, husky, as if 
scalded by hot fluid. Dark red, angry streaks of capillaries in the 
fauces; the whole fauces dark red and tumid; round gray spot 
where the redness first began. Viscidity of saliva." Dr. Reissig, 
of New York, first used this remedy without divulging it. Dr. 
Dunham drew the secret out of him, and since then Dr. Swan 
and different other physicians of good repute have published 
very severe cases cured by it. I consider the above proving as 
furnishing the best indications for its application. Dr. C. Lippe 
gives the following characteristic indications : " The ulcers go 
from one side to the other and back again ; the ulceration has a 
glistening, shining appearance (Apis) ; the swelling of the glands 
changes sides and is painful to the touch, and the nasal discharge 
excoriates the nostrils and upper lip (Arum, triph.). These charac- 
teristic ulcers, shining and glistening, may be found in any part 
of the body." 



304 MUCOUS MEMBRANE OF MOUTH. 

Laches., when the membrane develops first on the left and then 
on the right side ; when there is more subjective suffering than 
the objective signs would warrant to suppose ; when all the 
symptoms are worse after sleep. Tendency towards the larynx 
with croupy cough and intolerance of any external pressure on 
the throat ; badly smelling stools, even if formed ; dark, scanty 
urine of strong odor ; albuminous urine ; purplish eruption on 
the body; delirium, which changes rapidly from one subject to 
another ; somnolency ; hard aching all over, which makes the 
patient constantly change his position. 

Lycop., the color of the fauces is of a brownish redness, the exu- 
date commences on the right side and the pain is worse from swal- 
lowing warm drinks; the nose is stopped up, and the patient can- 
not breathe with his mouth shut; he keeps his mouth constantly 
open, slightly projecting his tongue, which gives him a silly ex- 
pression ; the nostrils are spasmodically dilated with ever}- in- 
spiration ; on awakening out of a short nap, he is very cross, kicks 
and behaves naughty, or jumps up in bed, stares about and knows 
nobody, seemingly dreaming with open eyes; frequent jerking 
of the lower limbs, mostly with a groan, awake or slumbering ; 
great fear of being left alone ; cannot bear to be covered. 

Merc. cyan. — This remedy was first recommended by Dr. Beck 
to Von Yiliers in a hopeless case of diphtheria, because of its 
having produced in five persons poisoned with this drug, gangrene 
of the velum palatinum and fauces. It proved successful. Ever 
since then Dr. Von Villers has used it in several epidemics under 
different latitudes with uniform success; higher dilutions operated 
better than lower. He began with the 6th and arrived at the 
30th cent. Several physicians who never saw any result from it, 
gave the 2d or 3d trit. or dil. When an epidemic of diphtheritis 
prevails, he administers it in every case of inflammation of throat. 
Lately (Allgemeine Horn. Ztg., vol. 99, p. 43, 1879) Dr. Grubenmann 
in St. Gallen confirms Dr. Von Villers' observations by stating 
that in a late epidemic, he cured with this remedy in its 15th to 
30th cent. dil. 50 cases, excluding all the light catarrhal forms at 
that time, without ever seeing the disease spreading to the larynx 
or showing any paralytic sequela?. It has also cured cases where 
the disease had already invaded the larynx. 

Merc, bin., left tonsil affected; velum elongated; gums and tongue 
more or less swollen and sensitive; constant collection of saliva 
and mucus in the mouth necessitates swallowing; swallowing of 
fluids or solids is painful. 



DIPHTHERIA, DIPHTHERITIS. 305 

Merc, prot, worse on rigid side; tongue coated thick on back 
part, of a buff-yellow color ; worse from warm drinks. 

Naja trip., suffocating spells on lying down, particularly when 
in bed ; must be taken up and held erect in order to procure 
easy respiration ; suffocative spells of cough after every sleep, 
however short. The cough is deep, hoarse; respiration wheezing, 
rasping, very tight and difficult, ameliorated during the morning 
from daylight to 11 a.m.; retention of urine; yellow watery 
stools. (M. Preston.) 

Natr. mur., swelling of the submaxillary glands and lymphatics; 
map tongue; burning in throat; after application of caustics, 
especially of nitrate of silver. 

Nux vom., feels better after a little sleep. (P. P. Wells.) 

Phytol., in cold weather, at the beginning with dryness and 
soreness of the throat, great headache, violent aching in the back 
and limbs; great prostration; cannot stand; gets faint and dizzy 
when rising up in bed. 

Plumb, met. and jod., have been recommended and successfully 
used by Schiissler; where there is inclination of the exudate 
to mortify and slough off; also in implication of the larynx. 
This was before the introduction of his tissue-remedies. 

Rhus tox., when the child is restless, wants to be carried about, 
wakes up every now and then complaining of pain in the throat ; 
when a bloody saliva runs out of the mouth during sleep; when 
the parotid glands are greatly swollen ; when there are trans- 
parent, jelly-like discharges from the bowels at stool or after- 
wards. 

Sulphur, large yellowish deposit all around the posterior wall 
of the pharynx, all posterior to the uvula and isthmus faucium. 
Quite lately, pulverized sulphur, blown at the diseased surface, 
has been lauded as a universal cure for diphtheria. 

Post-diphtheritic paralysis. 

Apis, numbness of the extremities. 

Arg. met, anaesthesia of the roof of the mouth and fauces. 

Arsen., paralysis of the lower extremities. 

Camphora, paralysis of the lungs. 

Caustic, paralysis of one arm and the muscles of deglutition. 

Gelsem., local tingling and incipient paralysis or anaesthesia; 
defective or impaired vision. 

Kali brom., anaesthesia of fauces. 

Nux vom., hemiplegia, left side. 

20 



306 MUCOUS MEMBRANE OF MOUTH. 

Phosphor., numbness of fingers and feet, with great weakness. 

Secale, numbness of the extremities; paralysis of some parts; 
painful tingling (like crawling of ants) on the tongue. 

Tart, emet, paralysis of the lungs. 

Besides, compare : Arnica, Baryt., Coccul., Cuprum, Plumbum, 
Rhus tox., Stannum, Sulphur, Thuja, Zincum. 

Noma, Gangrene of the Cheeks. 

The first symptom of this malignant but rare disease is a small 
blister, situated in the middle of the cheek, or toward the corner 
of the mouth on the inside of the cheek. It is filled with a pale- 
reddish or turbid grayish or brownish fluid. It bursts so soon 
that its formation is mostly overlooked, and appears afterwards 
as a superficial ulcer with an unclean basis, soon assuming a 
gangrenous character. Simultaneously with this blister, under- 
neath it, a small lump is found, which may be felt even outside 
on the cheek, which consists of infiltrated cellular and adipose 
tissue. Now the gangrenous destruction goes on rapidly, and on 
the outside appears an cedematous swelling of the diseased cheek, 
often shining fatty or oily, or appearing livid, pale or marbled. 
By and by, there is also formed outside, mostly on the middle of 
the cheek, an inflamed spot or blister upon a hard basis, which 
soon covers itself with a dark crust. This crust being removed, 
gangrenous ulceration appears under it, like that on the inside 
of the cheek, which spreads with the same rapidity, destroying 
in a short time the greater part of the affected side of the face. 

The general and concomitant symptoms seem at first to indi- 
cate nothing alarming. Generally the glands of the neck swell. 
and the face has a pale, cachectic aspect. Soon, however, there 
is a general sinking of strength, diarrhoea sets in, and death may 
ensue from exhaustion, before the gangrenous destruction extends 
over the whole cheek. 

This disease is mostly found in childhood, and always in 
sickly children, or after scarlet fever, measles, typhus, and some- 
times after small-pox. Adults are very seldom attacked by it, 
and then it appears only after typhus or puerperal fever, and 
especially after the abuse of mercury. 

THERAPEUTIC HINTS.— The main remedies recommended are, 
Arsen., Helleb., Secale, China, Carb. veg. 



NECK. 



General Observations. 

Ocular inspection of the neck externally, as a whole, presents 
various noticeable features. 

A short and thick neck, in consequence of hypertrophy of its 
muscles, is found in emphysema of the lungs; and 

A long, thin neck mostly accompanies tuberculosis. 

A spasmodic contraction of the neck backwards denotes meningitis, 
with exudation on the base of the brain. 

The external jugular vein puffs out in the triangular space, which 
is called the interstitium intersterno-cleido-mastoideale, in all 
cases where the free circulation of the blood through the thoracic 
cavity is interfered with, as in diseases of the heart, and in con- 
sequence of continued violent coughing, screaming, singing, and 
the like. A pulsation of this vein is observed in insufficiency of 
the tricuspid valve. 

The carotid artery is seen to pxdsate more strongly in feverish 
conditions, and where there is obstruction in the circulation 
within the brain; its jumping pulsation is a sign of insufficiency 
of the valves of the aorta. 

The acromial and supra-sternal regions sink in when the upper 
parts of the lungs shrink; and 

These regions become inflated during inspiration or expiration, 
when emphysema or caverns exist in the upper part of the 
lungs; also, during bronchitis capillaris of infants. 

Swellings of the neck are of various nature : 

They are emphysematous when, in consequence of internal or 
external injuries of the larynx or trachea, air penetrates into the 
subcutaneous cellular tissue; or when, in consequence of a rup- 
ture or laceration of the lungs, the air is forced through the 
mediastinum into the cellular tissue of the neck. 



308 NECK. 

They are (edematous in case of general dropsy, or when, by 
tubercular or scirrhous tumefaction of the lymphatic glands, the 
vena jugularis or anonyma becomes compressed; this causes at 
the same time an oedema of the face, or of the arm. 

There is a swelling of the lymphatic glands, either by infiltration 
with tubercular or scirrhous masses, or by becoming involved ; 
secondarily, in inflammatory processes of the mouth, throat, face, 
or scalp, of which we have spoken. 

Parotitis or mumps appears on the upper part of the neck in 
front and below the ear, while 

Bronchocele, Struma or Goitre, 

Which is an enlargement of the thyroid gland, appears lower, 
sometimes on one, sometimes on both sides of the neck. Simple 
enlargement or hypertrophy of thisgland is, according to Porta, 
found only in children and young persons, while in older persons 
struma is always a degeneration of this gland, consisting in forma- 
tions of cysts, which contain a thick, gummy, jelly-like substance, 
of a yellow or brownish color, and which are known under the 
name of colloids. According to Schuh these colloids are either 
interspersed between the substance of the gland, or they form 
separate round or oval appendages upon the gland, without in- 
volving the gland itself into the morbid process. 

The struma of new-born children consists, as above mentioned, 
in a simple enlargement of either the entire gland, or of one of 
its lobes, and interferes, sometimes seriously, by its pressure upon 
the trachea, with the child's respiration. In severe cases it may 
produce death in a day or two, or even a few hours after birth. 
This is especially the case, should the swelling extend under the 
sternum, or the sternal portion of the clavicle, or in case the 
muscles underneath the hyoid bone prevent its extension ex- 
teriorly. 

In regard to the combination of struma with tuberculosis we ma}' 
say that, where struma is developed, there tubercular affections of 
the lungs may be found, but they do not reach the stage of soft- 
ening or phthisis, so that struma excludes tubercular phthisis. 

Basedow's or Grave's disease has been treated of, under the 
chapter on the eyes. 

THERAPEUTIC HINTS.— Bellad., heat and rush of blood to the 
head; pain in swallowing; gland painful to touch. 



OESOPHAGITIS. 309 

Bromium, in juvenile subjects, with light hair, blue eyes, fair 
skin. 

Calc. carb., in scrofulous persons, worse towards new moon. 

Egg shell, divested of its inner coating, finely triturated, has 
been used successfully. 

Iodium, inveterate cases; the harder they feel, and the more 
other symptoms are wanting, the more Iodium is indicated; dark 
hair, dark eyes, dark skin. 

Natr. carb., pressing pain; round, hard swelling on the upper 
rigbt part of the gland. 

Natr. mur., and also Natr. sulph. have been given with success. 

Spongia is recommended by Hahnemann for goitre in persons 
who live in valleys. Besides compare: Ambra, Amm. carb., 
Badiag., Calc. fluor., Calc. jod., Caustic, Hepar, Kali jod., Lycop., 
Sulphur. 

CESOPHAGUS. 

The lower part of the pharynx narrows back of the laryngeal 
entrance into a tube through which the food in the act of swal- 
lowing is carried into the stomach. This tube is called oeso- 
phagus. Its inner wall lies entirely out of the reach of ocular 
inspection, and we must infer from other symptoms what its 
conditions are. The introduction of the probe, or bougie, teaches 
by mediate palpation merely, whether the passage is open or 
closed, and if closed, at what point; and if it brings up in its 
fenestra some morbid products encountered during its passage, 
it may also aid us in our diagnosis. Auscultation, first practiced 
by Hamburger, has thus far had no great practical results. 

Oesophagitis, Dysphagia InfLammatoria. 

The mucous membrane of the oesophagus, although a continua- 
tion of the mucous lining of the fauces, is little disposed to in- 
flammation, because of its thick epithelial covering. Still in- 
flammation may set in even here from thermal influences (taking 
cold), from mechanical irritation (by the lodgment of foreign 
bodies), and from chemical causes (the destructive action of cor- 
rosive substances swallowed by accident or design). It may also 
be induced by spreading from continuous parts of its mucous 
membrane (such as of the pharynx- or the stomach), or from in- 



310 (ESOPHAGUS. 

flamed parts outside of it, such as the vertebrae, the mediastinal 
connective tissue, or the lymphatic glands. And lastly it is 
found . sometimes in cholera, typhus, pyaemia, variola, and scar- 
latina. All these different forms of inflammation may produce 
ulcers of the oesophagus ; the catarrhal form, although the most 
favorable in this respect, may in its protracted chronic form pro- 
duce dilatation of this organ. "Worse are the forms produced by 
corrosion, scalding, foreign bodies, etc., especially if they extend 
to the deeper layers, when danger of stricture from cicatricial 
contraction of the ulcers is always at hand. One of the most 
constant symptoms of inflammation of the oesophagus in any of 
its forms is painful deglutition or even entire impossibility of 
swallowing with regurgitation of food or drink, hence the name 
Disphagia inflammatoria. 

THERAPEUTIC HINTS.— Aeon., violent pain in the middle of the 
chest through into the back, worse from motion. When swal- 
lowing, it feels as if the food remained lodged in the region of 
the heart; lying on back impossible. After mechanical injury. 

Arg. nitr., after burning with caustic ammonia; fauces red and 
swollen ; pain under the manubrium sterni ; face red and pupils 
contracted. 

Arnica, after mechanical injury. 

Arsen., cramp in oesophagus ; burning when swallowing ; food 
ejected as soon as it reaches the region of larynx. Chronic form 
with burning soreness behind lower end of sternum, worse when 
swallowing food ; can't bear closure of dress. 

Baptis., inability to swallow anything but liquids ; great aver- 
sion to the open air. Oesophagus feels constricted from above 
down to stomach. 

Bellad., pressing pain, like contraction, and a feeling as though 
a foreign body had lodged fast in the oesophagus. 

Canthar., if caused by a burn. 

Kali bichr., burning in the entire oesophagus; solid food is pain- 
ful and difficult to swallow, leaving a sensation as though some- 
thing remained there. 

Kali carb., liquids, still less solids, do not descend further than 
half way of the oesophagus, with pressure, stinging and burn- 
ing in the middle of the chest and opposite vertebra? : gulping 
and coughing up of watery phlegm; chilliness, dry mouth, 
nausea. 



STENOSIS (ESOPHAGI. 311 

Laches., an attempt to swallow solids causes a feeling as though 
something had gone - the wrong way, bringing on violent gagging. 

Mezer., violent burning and soreness in the upper half of the 
oesophagus; deglutition painful and difficult, especially after the 
abuse of mercury. 

Natr. mur., only fluids can be swallowed; solid food reaches 
only a certain place, whence it is ejected with fearful gagging 
and suffocation; hawking up of phlegm in the' morning; obsti- 
nate constipation. 

Nitr. ac, in syphilitic persons. 

Phosphor., inability of swallowing nourishment; weak and 
empty feeling across the abdomen with occasional shooting pain 
in that region; sensation of heat extending up the back; great 
nervous irritability. 

Plumbum, fluids can be swallowed without difficulty; solids 
come back into the mouth again; some hours after eating, 
burning in stomach and oesophagus; constipation; prostration; 
emaciation. 

Rhus tox., if caused by corrosive substances. 

Stramon., constriction and spasm of the muscles of the throat 
on each attempt to swallow ; also paralysis of the muscles of the 
pharynx. 

Stenosis (Esophagi, Narrowing of the (Esophagus. 

This state of things may be congenital (a very rare occurrence) 
or the consequence of compression from morbid changes of neigh- 
boring organs, such as the glands of the neck and mediastinum, 
or large strumous masses when they extend far back so as to sur- 
round the tube; or be caused by foreign bodies of various kinds 
which in .the act of swallowing have stuck fast, or have gradually 
grown there, to which latter class belong all fungoid, polypous 
and carcinomous growths; or it may be the consequence of pre- 
vious inflammation and its consequent contracting cicatrizes, 
causing True stricture of the oesophagus; or it is a mere transient 
contraction of the muscular layer of the oesophagus, chiefly ob- 
served in hysterical or hypochondriacal patients, constituting 
Spastic stenosis. In all these cases the characteristic symptom is 
difficulty of deglutition. Where the occlusion forms gradually, 
the patient at first merely feels some obstruction to the free pas- 
sage of the food, especially if solid, which, however, is overcome 



312 (ESOPHAGUS. 

by drinking a little Avater or other fluid; gradually, however, 
when the stricture becomes greater, the food does not go down by 
these means and it is either kept in that region of the oesophagus 
until it gradually works its way through the narrowed space, or 
it is ejected. The higher the stricture, the sooner will regurgi- 
tation follow. 

THERAPEUTIC HINTS.— Bellad., when too large a morsel or a 
bone incites contraction of the oesophagus and holds it fast, 
Bellad., generally relieves this spasm and lets the swallowed 
body down. 

Cicuta, when, after swallowing a sharp piece of bone, the oesopha- 
gus closes and there is danger of suffocation. 

Grelsem., warm fluids, spirituous fluids can partially be swal- 
lowed ; cold drinks come up immediately. (Dr. Erwein). 

Hydrophob., periodical spasms of the oesophagus, with constant 
painful urging to swallow, but impossibility of doing it ; abhor- 
rence of fluids, especially of water; burning, stinging in the 
throat; cough; gagging; difficult and incorrect speech. 

Hyosc, spasmodic contraction after a previous injury of the 
oesophagus; solid and warm food can be swallowed best; fluids 
cause spasms in the throat, stop respiration and talking; hic- 
cough, nausea, spasmodic cough, and stiffness of the muscles of 
the neck. 

Naja trip., spasmodic contraction of the oesophagus. 

Ver. alb., spasmodic contraction with suffocation. 

Compare also the remedies under the foregoing chapter. 

Dilatation of the (Esophagus. 

Where there is stricture, the parts of the oesophagus above 
sometimes become dilated from the lodgement of food in that 
locality; but not always, because the muscular layers eject again 
what cannot pass down. But when these muscles lose their con- 
tractile power, a dilatation of the tube above the stricture is una- 
voidable. It is greatest just about and above the stenosis and 
diminishes as it ascends. These dilatations of the oesophagus 
have been called Stagnation aktesise. 

Then again dilatations of the oesophagus have been observed 
witliout any stenosis, either of the whole canal or of only a por- 
tion of the same; they are usually widest near the middle of the 



DILATATION OF THE OESOPHAGUS. 313 

tube. The wall of the oesophagus is in some cases thinned, in 
others thickened by muscular hypertrophy and the course of the 
tube is crooked, its lining membrane at times affected with ero- 
sions and ulcers, and its inner space filled with a brownish, pulpy 
mass, or small particles of food. " The greater number of these 
patients had suffered for many years from severe dysphagia, 
vomiting, regurgitation of food shortly after eating, and repeat- 
edly from actual rumination." (Zenker and Von Ziemssen). Of 
their remote cause nothing is known. 

A last variety of oesophageal dilatation are the Diverticula, 
which consist of protrusions or bulgings of a limited portion of 
the oesophageal wall, forming blind appendages to the normal 
canal. They are of two kinds : first, such which arise from press- 
ure within the canal outward (Pressure diverticula), and secondly, 
such in which the wall of the oesophagus is pulled out by some- 
thing exercising traction from without (Traction diverticula). The 
first are very rare and almost exclusively situated at the lowest 
part of the pharynx, just at the upper boundary of the oesopha- 
gus, and on the posterior wall, sometimes exactly in the median 
line, and sometimes somewdiat laterally. Here the arrangement 
of the muscular fibres greatly favors a separation between their 
bundles, as they run in parallel lines in a very thin layer, trans- 
versely, from one side to the other, without being interlaced by 
oblique as above, or by longitudinal fibres as below this spot. 
Here foreign bodies are easily lodged, the continuous pressure 
from swallowing does satisfactorily explain the widening out of 
this portion of the oesophagus. It is an affection of advanced 
age, and causes great difficulty in swallowing, regurgitation of 
food, and the consequent symptoms of starvation. 

The Traction diverticula are of more frequent occurrence and al- 
ways found at the anterior wall of the oesophagus, mostly at a point 
corresponding to the biforcation of the trachea, or else close by, 
above or below it, but sometimes also higher up or lower down. 
They are mostly funnel-shaped and of only a moderate depth. 
Their outside apex is grown to a firm, contracted tissue by which 
traction is exercised as from a cicatrice. The starting point has 
been an inflammatory swelling of the parts immediately adjoin- 
ing the oesophagus, leading at first to adhesion with a limited 
portion of the oesophageal wall and afterwards by shrinkage to a 
pulling out of that portion of the oesophagus. It is in fact a dis- 
ease of the tracheal and bronchial glands, especially those at the 



314 LARYNX AND TRACHEA. 

bifurcation, incidental even to childhood. They do not cause 
dysphagia, but their ulceration and perforation at the apex, 
which may be set up by irritating substances, pieces of bones, 
etc., collected therein, causes a destructive process in the medias- 
tinum and in its further progress may perforate the bronchi, and 
cause bronchitis, gangrene in the lungs, ichorous pleuritis, peri- 
carditis or even perforation of arterial trunks. 

The existence of these traction diverticula is in most cases not 
even suspected during life. However a frequent detention of 
food at a fixed spot, pretty low down, particularly the slight de- 
lay of granular food, like barley or rice, should at least direct the 
attention of the careful practitioner in that direction, notwith- 
standing such symptoms may have several other explanations, 
and be sufficient reason to enjoin upon the patient the use of soft 
food and the habit of drinking after eating in order to wash out 
any remains of food from the diverticulum. 

THERAPEUTIC HINTS.— As dilatations are frequently associated 
with loss of muscular contractile power, the following remedies 
which have proved beneficial in paralysis of the throat, should be 
consulted: Arsen., Baryt. carb., Caustic, Conium, Calc. carb., 
Hepar, Iodium, Mur. ac, Stramon., Yer. alb. 



LARYNX AND TRACHEA. 
Auscultation. 

On putting the ear to the stethoscope, which must be evenly 
placed upon the larynx, we hear the rushing in and out of the 
air during the act of respiration much louder than on any other 
place. It may be imitated by blowing with compressed lips 
through the bore of the stethoscope, and is called laryngeal or 
tracheal respiration, for at the trachea too, it is heard in the same 
degree. 

Some authors lay great stress upon the necessity of auscultating 
these organs. I cannot attach such great importance to it, either 
diagnostically, or still less therapeutically. The only benefit 
afforded by auscultation in diseases of the larynx and trachea, 
properly so called, is the possibility of localizing by.it the source of 
obstruction, if there be any; but whether that obstruction arise 
"from inflammatorv enooraement of the lining membrane, from 



LARYNGOSCOPY. 315 

solid effusion upon the internal surface, or from fluid effusion 
beneath it, or if in consequence of preceding ulceration any 
contraction exist, either in the rima glottidis, or in the course of 
the trachea, which gives rise to constriction of the tube, and 
thereby impedes the free ingress and egress of air, or whether a 
foreign body, fixed in the oesophagus and pressing upon the 
trachea, or situated in the trunk itself of the air-passages, or a 
tumor, or a mere spasmodic action, be the cause of this constriction 
— auscultation telleth not. In each of these cases the noise is 
usually sufficiently obvious, and the evidence of obstruction is 
sufficiently clear, independently of auscultation. By the stetho- 
scope we are enabled merely to say that obstruction exists and to 
indicate its seat ; but the nature of that obstruction is not revealed 
by it." (H. M. Hughes.) 

Inspection, Laryngoscopy, is of much greater importance. We 
need for its execution a throat mirror and suitable illumination. 
The throat mirror is round and consists of white glass, thoroughly 
polished and well silvered, and strongly fastened at an angle of 
45° to a strong rod, one-sixteenth of an inch thick and six inches 
long, which terminates in a suitable handle, five or six inches 
long. The size of the mirror must be suited to the capacity of 
the patient's throat, from four-tenths of an inch to one and a 
quarter inches in diameter is its boundary ; the intermediate sizes, 
say seven-eighths of an inch in diameter, are probably the most 
convenient for general use. 

The illumination may be procured from the direct rays of the 
sun, from diffused daylight, or from artificial light (oil lamp, 
candle or gaslight). 

• The direct rays of the sun and diffused daylight, the best of 
which comes from a window facing the north, thus being re- 
flected from the northern sky (Dr. Woodvine), need no reflectors. 
With artificial light, reflectors are necessary. They are either 
held with one hand, which scarcely ever is practiced on account 
of its inconvenience, or they are fastened upon the forehead of 
the examiner (compare the examination of the nose), or they 
are screwed, movable in every direction, on the handle of the 
throat mirror (an invention of Dr. Elsberg, Clinical Professor of 
Diseases of the Throat in the University of New York), or they 
are added in different ways to the illuminating apparatus, gen- 
erally complicated and expensive contrivances. 

Of all these means, Dr. Elsberg's seems the simplest and the 



316 LARYNX AND TRACHEA. 

one most easily applied. His directions for the employment of 
this apparatus, which he calls the pocket laryngoscope, are the 
following : 

" I will first suppose the examination is to be made in the day 
time, in the absence of direct sunlight. Seat the patient with 
his back to the window, let him open his mouth and protrude 
his tongue by a strong effort of his will, and let him hold the 
tongue out with his index-finger and thumb of his right hand, 
covered by a handkerchief. As I want to give minute practical 
directions, I must say here that a great deal of awkwardness is 
prevented by placing the handkerchief between the middle and 
index-fingers, turning it over so as to cover the index-finger and 
thumb spread far apart, and closing the little and ring finger 
upon the handkerchief; the thumb and index-finger then taking 
hold of the tip of the tongue, the thumb should rest against the 
chin, and by an outward and downward movement arch out the 
tongue. When the patient does not succeed in properly holding 
out his tongue, the examiner must hold it with his left hand. 
The little mirror is warmed until the film of condensation which 
settles upon it passes off; its temperature may be ascertained by 
bringing its metallic back into contact with the examiner's 
cheek or the back of his hand ; it is then, without touching the 
tongue, introduced into the mouth, taking the uvula upon its 
back. Keeping the parts well illuminated by means of the 
reflector, on depressing the handle a little, the epiglottis will be 
seen in the mirror ; and getting the patient to breathe deeph T , 
say "a," laugh "hah, hah, hah!" as heartily as possible, etc., 
and very slightly moving the handle, the various parts of the 
interior of the larynx and neighboring organs will be brought 
into view. 

"When artificial light has to be employed, the patient should 
sit so that it is a little back of him, and on his right side. In all 
other respects the mode of examination is unchanged. The 
pocket laryngoscope may be used with sunlight, or diffuse day- 
light, or oil lamp, candle or gaslight; and in the latter case the 
ordinary high gas fixture answers the purpose almost as well as 
a drop light or stand. Ten minutes practice familiarizes any 
one with its use. 

"For auto-laryngoscopy an extra looking-glass is necessary 
which, when the mouth can be illuminated by direct sun or arti- 
ficial light, may be in the handle instead of the reflector ; other- 



ACUTE CATARRHAL LARYNGITIS. 317 

wise, it must be placed in any convenient manner in front of the 
examiner." 

It will be well to commence practicing this little art either on 
one's self or another healthy subject, in order not only to acquire 
the skill of introducing the throat-mirror and holding it in a 
suitable position for a full illumination of the larynx, but also 
on account of acquiring a thorough knowledge of the parts, their 
color and their movements when in a healthy condition; abnormal 
condition will then at once spring into notice. 

Acute Catarrhal Laryngitis, Catarrh of the Mucous Lining 
of the Larynx. 

It may not amount to more than a rosy injection of the poste- 
rior ends of the vocal cords and some of the parts adjoining; it 
may extend to the ventricular bands (false vocal cords), to the 
arytenoid cartilages, upon the epiglottis and into the trachea, 
causing swelling, redness and ecchymotic spots of these parts ; it 
may even terminate in oedema of the larj^nx and hgemorrhagic 
extravasation upon its free surface, or hemorrhagic infiltration 
of the mucous membrane and the submucous connective tissue. 
These different states naturally produce different symptoms of 
the disease. From a mere slight huskiness of voice the hoarseness 
may increase to aphonia, in consequence of the greater or less 
swelling of the vocal cords and the parts around them, and the 
innervation or alteration of the laryngeal muscles. 

The difficulty of breathing, which in adults rarely attains to any 
great degree, may in children increase to gasping and struggling 
for breath, simulating croup, wherefore the name of Pseudo-croup 
has been adopted by most recent writers for this state of affairs. 
These attacks of stenosis are due partly to the relatively great 
amount of swelling of the mucous membrane in comparison with 
the narrowness of the true and false glottis, and partly to the 
secretion, which dries upon the parts during sleep and increases 
the obstruction. The child then rouses suddenly in the middle 
of the night with a harsh, croupy cough and distress for breath ; 
the stridor, however, is solely inspiratory, and the expiration 
takes place noiselessly. After the secretion is liquified, these 
symptoms abate. 

The cough, too, varies in its character. We observe paroxysmal, 
spasmodic attacks, resembling whooping-cough, followed by a 



318 LARYNX AND TRACHEA. 

drawn inspiration, also cough of various sounds and timbre, or 
without tone, in consequence of the greater or less swelling of 
the vocal cords and their adjoinings. At first it always sounds 
dry but becomes looser as the secretion of the inflamed parts in- 
creases. In the beginning it is very scanty, clear and trans- 
parent, sometimes mixed with blood in the form of fine streaks, 
later it becomes more abundant and consistent, changing to yel- 
low from the increased number of pus-cells. 

There is also more or less pain in the larynx, a disagreeable 
feeling of dryness or irritation, as if from a foreign body. Its 
severity does not always correspond to the amount of the inflam- 
mation; the latter may be trifling and yet its annoyance great. 

Difficulty in swallowing occurs only when the epiglottis and the 
posterior surfaces of the arytenoid cartilages and ary-epiglottidean 
folds are considerabl}' implicated in the inflammation. 

Such an acute attack lasts in some cases from five to nine days, 
in others weeks, and in still others it becomes chronic. 

Its Causes are very numerous. A predisposition to it seems to 
exist in persons who perspire easilj T , who are weakly, cachectic, 
and who keep themselves too warmly clad, or too much housed 
up, etc. 

Exciting causes are all irritating agencies, such as breathing of 
cold air, dust, acrid vapors, screaming, singing, etc. ; talcing cold ; 
getting the feet cold ; sudden exposure of the neck to cold air, 
etc.; catarrhs, colds in the head, influenza, pharyngitis after drink- 
ing strong drinks; persons get hoarse after debauchery, all show- 
ing a spreading from contiguous parts ; and some constitutional 
diseases, as measles, exanthematic typhus, syphilis, and especially 
tuberculosis, which latter generally causes a constant disposition 
to " catch cold in the throat." 

THERAPEUTIC HINTS.— Aeon., in the beginning, after exposure 
to cold, west winds ; fever with hot, dry skin, great restlessness 
and impatience. Waking up in the middle of the night with 
croupy cough and breathing, pain in the larynx and great anx- 
iety. Also after straining the voice in singing. 

Bellad., spasmodic, barking cough, waking suddenly about mid- 
night ; pain in larynx, headache, fever, drowsiness ; sudden loss 
of voice. 

Bromium, rough, scraping feeling in the throat, with oppression 
of breathing ; husky, hoarse voice ; croupy cough ; fair skin. 



ACUTE CATARRHAL LARYNGITIS. 319 

Bryon., cough worse from motion, from entering a warm room, 
and with pain in pit of the stomach. From changes in the 
weather, either to warm or cold. 

Calc. carb., teething infants ; rachitic children. 

Carb. veg., hoarseness worse in the evening; cough coming in 
spells, usually far apart. 

Caustic, entire loss of voice, or great hoarseness, worse in the 
morning, with rawness and burning in the throat. 

Chamom., continued dry cough from tickling in the larynx, 
worse at night ; feverishness ; restlessness; impatience; irritable- 
ness. One or both cheeks flushed ; hot perspiration about the 
head. 

Drosera, constant tickling in the larynx, causing cough and pre- 
venting sleep at night. 1st dil. in water. (Baumann.) 

Dulcam., when the trouble gets renewed on every sudden change 
of the weather from warm to cold. 

Hepar, croupy cough, worse in the morning ; hoarseness; in fall 
and winter from dry, cold west winds. 

Iodium, tickling cough; husky voice; constriction of larynx; 
worse in morning. 

Laches., dryness in throat; sore spot on left side of larynx; feel- 
ing as of a lump in the throat ; choking sensation in the throat ; 
cough excited from talking, laughing ; irritation as if in pit of 
stomach. 

Mercur., chilliness during the fever whenever moving the feet 
to a cool place in the bed ; easily perspiring without improve- 
ment ; cold in the head. 

Nux vom., in the commencement with chilliness, headache, 
stoppage of nose. From exposure to draughts, or sitting in a cold 
room. 

Phosphor., constant tickling cough from the larynx, also with 
headache as though it should burst ; cough dry ; worse from 
evening until midnight, with tightness across the chest. 

Pulsat, chilly, thirstless ; worse in the evening and in a warm 
room. 

Rhus tox., tickling under the middle of the sternum ; worse 
from talking or laughing ; pain in all the bones w T orse when be- 
ing quiet. After straining the voice in singing or speaking. 

Rumex, dry cough in paroxysms, induced by hurried or deep 
inspirations, speaking, inhaling of colder air than usual, or any 
pressure upon the trachea in the pit of the throat. 



320 LAKYNX AND TKACHEA. 

Sanguin., highly recommended by Dr. Mcho-1. 

Spongia, fever and irritation in throat, with hoarse, croupy 
cough, worse from evening ; breathing wheezy ; spells of chok- 
ing in the middle of the night. 

Tart, emet, rattling cough and breathing ; trembling pulse ; 
sticky perspiration ; no thirst ; pale face ; peevishness ; drow- 
siness. 

Laryngitis Catarrhalis Chronica. 

The chronic catarrh of the larynx results often from continued 
exposure and neglect of an acute attack, or from a continuous 
series of irritations by overexertion of the voice in talking and 
singing, or from a chronic pharyngitis in consequence of the 
abuse of tobacco and alcoholic stimulants. 

We find swelling and injection of. the mucous membrane either 
limited to certain parts, or diffused over the whole organ, with a 
velvety sponginess of its lining membrane. The redness shows 
less distinctly on the vocal cords than upon the other portions of 
the mucous membrane; the swelling and thickening of the vocal 
cords gives to their surface a granulated, and to their edges an 
uneven appearance. The tumefaction of the epiglottis or of the 
ventricular bands, or of the ary-epiglottidean folds, amounts 
sometimes to distortion of these parts. With all this the affected 
parts are usually covered with dilated veins. Ulcerations, ex- 
cept in follicular inflammation, perichondritis, and oedema, are 
very rare results of this disease, but on the other hand, secondary 
chronic laryngitis is almost always accompanying syphilis, ul- 
cerative processes, neoplasms, traumatic irritations and peri- 
chondritis. 

This state of things necessarily causes various alterations of the 
voice from slight huskiness, to deep hoarseness and loss of tone. 
It is always attended with clearing, hemming and hawking, 
when speaking, on account of the collection of phlegm in the 
throat, and^the sensation of something there that ought to be re- 
moved. The secretion is either clear, transparent or whitish- 
gray, frothy with minute bubbles, or viscid, ropy, or yellowish 
from numerous pus-cells. There is also more or less cough ex- 
cited by the laryngeal irritation, which, like the voice, is hoarse 
and of an unusual timbre. The subjective sensations are mostly 
those of rawness, scraping, soreness and burning in the larynx, 
aggravated by the use of the voice. 



LARYNGITIS CATARRH ALIS CHRONICA. 321 

THERAPEUTIC HINTS.— Any of the remedies detailed under the 
foregoing chapter may be indicated here. Besides these, one or 
the other of the following may be required. 

Arg. nitr., pharyngo-laryngeal catarrh. Weakness and tremu- 
lousness; palpitation of the heart. 

Arsen., the lining of the larynx more or less injected, puffy or 
swollen; voice oftener husky than hoarse, or dull without reso- 
nance or timbre. Sensation of dryness, fatigue and tickling in 
speaking; burning in the throat. Delicacy of constitution; dis- 
position to tubercular deposits. 

Calc. carb., the lining of the buccal cavity extremely pale; soft 
palate and pharynx covered with dilated veins, coloring the parts 
bluish; throat dry, tongue white. Speaks in a whisper; an at- 
tempt to talk loud gives a muffled sound and causes a short, 
hoarse, barking cough; cough worse from evening till midnight. 
Complexion waxy; lips almost white; face puffy, particularly 
the eyelids, with dark rings around the eyes ; hands and feet cold 
and moist. Listless disposition ; disagreeably impressed by music 
and noise; inability for mental or physical exertion, so weak, is 
hardly able to walk ; exertion causes palpitation and breathless- 
ness; night-sweats. 

Carb. veg., swelling of the vocal ligaments; the lining of the 
larynx and particularly of the ventricular bands, of a dingy pur- 
plish tint; hoarseness worse in damp weather and in the evening; 
loss of voice; expectoration moderate, lumpy and easy. Reduced 
vitality; venous capillary dilatation of pharyngo-laryngeal parts, 
and prevailing torpor of all functions ; cold knees in bed. 

Caustic, loss of voice; great hoarseness, worse in the evening; 
as soon as he tries to raise his voice to a higher pitch, it gives 
out, or becomes a squeak. Hoarseness of singers and speakers. 

Hepar, tuberculous disposition; scanty, tenacious, muco- puru- 
lent secretion with difficult expectoration. Seated pain in one 
spot of the larynx, aggravated by pressure, speech, cough and 
breathing. 

Iodiirm, follicular catarrh with ulceration; constant tickling 
cough. Great hunger and yet emaciation. 

Kali bicbr., pharynx bluish and with varicose veins ; the vocal 
cords and the posterior parts of the larynx are red and puffy and 
covered with grayish mucus ; sensation of dryness ; tickling in 
larynx when speaking ; voice rough and hollow ; cough with 
scanty, stringy expectoration, provoked by speaking or laughing. 



322 LARYNX AND TRACHEA. 

Kali hydr., arytenoids of a purplish color, tumefied, and gran- 
ular ; follicular ulceration ; voice hoarse ; sounds above the 
middle key impossible ; dry cough ; sensation of dryness, burn- 
ing and tickling in larynx. 

Mangan., venous dilatation in the throat and pharynx ; partial 
injection of the ventricular bands ; hoarse voice in the morning, 
better after clearing up lumpy mucus; weak, anaemic individuals 
with disposition to tuberculosis. 

Natr. mur., follicular inflammation of pharynx ; after swabbing 
the throat with nitrate of silver. 

Nitr. ac, ulcers in the larynx ; toneless voice ; previous mer- 
curial abuse. 

Phosphor., lining of vocal cords highly injected with ulcera- 
tion ; suppressed voice ; talking provokes tickling in larynx and 
spasmodic cough, followed by great drjmess and burning in the 
throat. 

Sanguin., sensation of dryness, soreness and swelling in the 
larynx, and expectoration of thick mucus; redness in the throat; 
stoppage of the nose, with headache across the eyebrows. 

Sulphur, cough in the evening, before and when going to bed ; 
catarrh of other mucous membranes ; disposition to skin affec- 
tions ; suppressed eruptions. 

Croup. 

Croupous laryngitis produces a fibrinous exudation upon the 
mucous surface, which coagulates and forms a false membrane, 
loosely attached, but frequently regenerated. It is therefore 
nearly related to diphtheria, which in some cases also extends 
to the larynx, causing all the symptoms of true croup. It differs, 
however, from diphtheria, in that the exudation never leaves 
scars behind. In diphtheria, especially in severe cases, the mu- 
cous membrane as well as the submucous tissues become de- 
stroyed, and cicatrize on healing. Croup may commence in the 
fauces and extend downwards, or in the larynx and spread up- 
wards. In almost all cases there is a hypersemie state of the 
whole mucous membrane of the trachea and bronchial tubes, 
which at times augments to a croupous exudation in these parts. 

Ocular inspection reveals the pseudo-membrane in the fauces, 
if it commences or extends there ; laryngoscopy is in most cases 
impossible ; auscultation reveals nothing but what we can hear, 
even at a distance, — labored breathing, with a sawing sound. 



croup. 323 

Croup generally attacks children in early childhood, — from 
two to seven years and seldom more than once. 

Its Premonitory Signs consist at times in peevishness, fever- 
ishness, soreness of the throat, inflammation of the tonsils and 
fauces, with patches of exudation, as in diphtheria. In other 
cases there are no such forebodings. The child is aroused sud- 
denly out of a sound sleep, generally about midnight, by a hoarse, 
dry, croupy cough. It exhibits restlessness and fright, and fre- 
quently puts its hands to the windpipe. Soon, however, it falls 
asleep again, to be again roused by the same dry, hoarse cough, 
alternating in this way until morning, when usually a remission 
takes place, and the child seems to be lively and playful. When 
evening approaches, the child becomes worse again, and, in addi- 
tion to the cough, we observe the breathing to be getting impeded 
between the coughing spells. Not only can we see the labored 
action of the respiratory muscles, but we can also plainly hear a 
sawing noise, which the ingress and egress of the air causes in the 
stuffed-up air-passages. This difficulty increases from hour to 
hour. The child involuntarily bends its head and neck back- 
wards, in order to free the windpipe as much as possible from all 
pressure ; the alse nasi move strongly up and down like wings ; 
the epigastric region does not, as is usual during the act of in- 
spiration, bulge out, but is drawn in, in consequence of a defi- 
ciency of air in the lungs on account of the obstruction in the 
larynx. For the same reason we find the xiphoid process and the 
cartilages of the lower ribs during inhalation drawn strongly in- 
wards, instead of gliding gently downwards, as is natural. When 
we find inhalation and exhalation equally difficult, there is surety 
coagulated exudation around the glottis ; when, how r ever, as is 
sometimes the case, only the inspiration is difficult and expira- 
tion easy, it is probable that the difficulty does not lie in the 
presence of a pseudo-membrane, but in a paralytic state of the 
muscular structure of the glottis, whereby the epiglottis, during 
inspiration, is not lifted up from the glottis, thus hindering the 
free ingress of air ; while during exhalation the paralyzed parts 
easily give way to the returning stream of air. 

Thus the child struggles terribly for air ; raises up, wants to be 
carried about, until from sheer exhaustion and the carbonized 
state of the blood, it sinks into drowsiness and stupor. The face, 
being at first red, grows pale, finally cyanotic and is covered with 
cold sweat ; the pulse, at first quick, hard and strong, grows very 



324 LARYNX AND TRACHEA. 

frequent, small, irregular, intermitting, until at last this fearful 
scene is closed by general paralysis or suffocation. The tempera- 
ture may not exceed 101.3° F. in some cases, while in others, espe- 
cially in complications with bronchitis or pneumonia, it may rise 
from 104° to 105.8°. 

In those cases in which dissolution of the false membrane, or 
the tearing, loosening and ejection of it, permits recovery, we fre- 
quently find a long-continued hoarseness, caused by catarrh of 
the larynx, or bronchitis or pneumonia, the latter being compli- 
cations which did already exist during the attack, and made it 
so much the more serious. 

Secondary croup occurs during the course of acute, infective or 
general constitutional diseases. Of the acute exanthemata, Measles 
is the one most frequently complicated with it, and especially 
during the stage of desquamation, while pseudo- croup occurs 
usually as a prodromal symptom of measles. Scarlatina, too, and 
Small-pox, when complicated with throat-diphtheria, are apt to 
produce laryngeal croup; the most fatal complication is that 
with Epidemic diphtheria. Some authors have observed secondary 
croup during the height of whooping-cough, and in the course of 
typhoid fever, pneumonia and cholera. 

True croup is most readily confounded with Catarrhal laryngitis 
or Pseudo-croup; the latter, however, is frequently attended with 
other catarrhal symptoms, such as sneezing, coryza, etc., and apt 
to recur frequently. Diphtheria is thought by some writers (Wag- 
ner and others) not to be an essentially different affection from 
croup, and that there is no sharp dividing line between the two. 
But if we take in consideration that in croup the exudation takes 
place upon the free surface of the mucous membrane, and in 
diphtheria also within it, causing necrosis and loss of substance, 
that diphtheria is contagious while croup is not, and that in 
many cases of diphtheria a peculiar penetrating smell from the 
mouth claims at once our attention, we shall hardly find any 
difficulty in distinguishing between the two, notwithstanding 
the close similarity of symptoms between them. 

The Prognosis of true croup is a great deal more favorable 
under homoeopathic treatment than under allopathic. "While 
practitioners of the old school of known ability and honesty con- 
fess to the most dreadful losses" (Steiner), we of the Halmemaim- 
ian school have a right to boast of brilliant cures, if boasting it 
be when physicians of "known ability and honesty " state their 
successes. 



croup. 325 

How a man like Johann Steiner can call these men swindlers 
and ignoramuses, men who at least in therapeutic science stand 
far above him, is explainable only when we understand the be- 
clouding influence of bigotry over sound judgement. 

THERAPEUTIC HINTS.— Acid, ac, has been used successfully by 
Dr. Krebs. I have found it curative in a case that did not yield 
to other remedies and which was characterized by a remarkable 
bright redness of the face. From five to ten drops of acetic acid 
in half a tumblerful of water with some sugar make a pleasant 
acidulated drink. I gave a teaspoonful of it every two or three 
hours with speedy effect. 

Aeon., high fever, dry skin, restlessness; the child is in agony, 
impatient and throws itself about. 

Arsen., worse about midnight; great restlessness notwithstand- 
ing prostration; bloated face, covered with cold perspiration. 

Bellad., sawing, whistling breathing, frequent barking, croupy 
cough; skin dry and hot; face red; pulse full and sharp; very 
restless; tonsils red and swollen; patches of exudation on the 
fauces; midnight attacks. 

Bromium, when after Spongia aggravation again sets in next 
evening; especially in children with blue eyes and light hair. 

Calc. carb., in a case of marked calcarea constitution. (H. V. 
Miller.) 

Canthar., in cases where the voice was entirely gone, and there 
was whistling breathing, and tossing about in bed with the great- 
est agony. 

Caustic., sensation of rawness in the larynx. (E. C. Price.) 

Hepar, cough worse in the morning; mucus rattling and yet 
no getting rid of the phlegm ; hoarseness ; dry, barking cough ; 
the child cries when coughing; after exposure to cold west wind. 

Iodhim, as Bromium follows well after Spongia, so does Iodium 
after Plepar; cough worse in the morning, rattling and no get- 
ting loose; hoarseness; especially in children with black eyes 
and dark hair. 

Kaolin, first recommended by Aegidi; it seems to be especially 
indicated where the croupous inflammation has its seat in the 
lower portion of the larynx or in the upper part of the trachea, 
which may be recognized by the much more laboring and saw- 
ing respiration. (I. Landesmann.) 

Kali bichr., worse early in the morning; inflamed fauces; mem- 
branous deposition; hoarseness; fat, chubby children. 



326 LARYNX AND TRACHEA. 

Laches., the child cannot bear anything touching its throat; 
aggravation in the afternoon, after and during sleep ; patches of 
exudation in the fauces ; commencing paralysis of the lungs. 

Lycop., spasmodic motion of the alse nasi ; crossness after sleep ; 
can't bear to be covered. 

Phosphor., in combination with bronchitis; great weakness; 
aggravation evening up to midnight; lying on back provokes 
the cough. 

Sanguin., in a case with whistling cough, or of metallic sound, 
as though coughing through a metallic tube. 

Spongia, very dry, crowing sound of cough; always commenc- 
ing to get worse in the evening; sawing sound of respiration even 
during remission. 

Tart, emet, face cold, bluish, covered with cold perspiration; 
pulse very frequent; rattling as if the chest and trachea were 
full of mucus without expectoration; great sinking of strength; 
commencing paralysis of the lungs. 

Von Grauvogl advises: 

Cuprum, when spasmodic affections, such as asthma spasmod- 
icum, whooping-cough, chorea; or cholerine, etc., are prevalent 
(epidemic) at the time with other people. 

Ipec, Iodium or Bromium, when intermittent affections prevail. 

Hepar, when panaritise, anginse, urticaria, or erysipelas are the 
prevailing diseases. 

Schussler advises: 

Kali mur. at first, or 

Ferr. phosph., when there is violent fever. 

Calc. sulph. later, if required. 

Kali phosph., in cases coming too late under treatment, with 
great weakness, pale, bluish face, etc. 

Tracheotomy. — " Out of quite a large number of cases occurring 
in my practice, before I had adopted the operation of tracheotomy, I 
saw but three recoveries; since 18G3, however, this discouraging 
rate has been so much improved by the employment of trache- 
otomy that the mortality has at different times amounted only to 
sixty, sixty-five and seventy per cent. Bricheteau states it at 
sixty-nine, Franque at sixty-eight, Trousseau at fifty, and Greve 
in Sweden at twenty -three per cent." (Steiner.) "Among the 
1,698 cases of tracheotomy collected by Duchek, a favorable re- 
sult occurred in 428 operations, a proportion of 1 to 3.9 (25.2 per 
cent.), which is probably the correct average.'' (Steiner.) 



(EDEMA GLOTTIDIS, (EDEMA LARYNGIS. 327 

"In fatal cases of croup, where the symptoms consist of great 
dyspnoea, pallid face and lips, cold extremities and very feeble 
pulse, post-mortem examination will disclose fibrinous deposits 
in the heart, and such cases, if operated upon, are sure to die! 
while if there be turgescence and lividity of the face, with blueness 
of the lips, accompanied with extreme dyspnoea, the obstruction 
is evidently in the trachea, and the case, therefore, offers much 
greater hope of recovery by operation." (Dr. Richardson, of 
London.) 

"Tracheotomy is no more curative of croup than are emetics; 
it cannot even arrest the croupous process; its only office is to 
establish a new provisional air-passage while the clanger of death 
from laryngeal stenosis lasts, and to assist Nature in her efforts 
to cure; and no other means fulfil these indications so certainly 
and so directly." (Steiner.) 

In short, although tracheotomy is not a sure cure for croup, it 
may in violent cases procure time for the selection and action of 
the medicine which finally will subdue the croupous process and 
thus be a means of saving the child. This is applicable even to 
Homoeopathic treatment. 

(Edema Glottidis, (Edema Laryngis 

Consists of a serous or sero-purulent infiltration of the submucosa, 
following either inflammatory or non-inflammatory processes. 

The inflammatory form has been designated as Laryngitis phleg- 
monosa, embracing all such inflammations of the larynx which 
have their seat principally in the submucous connective tissue. 
It is always of a secondary nature, and may be the consequence 
of a catarrhal laryngitis when renewed attacks or new injuries 
spread the inflammation in depth to the submucous connective 
tissue, or it is connected with laryngeal diphtheria, or the conse- 
quence of chemical or thermal irritants or mechanical irritations by 
foreign bodies ; or it is an extension of inflammatory processes 
from neighboring parts, such as wounds of the larynx and its 
vicinity, or retro-pharyngitis, tonsillitis, pharyngeal diphtheria, 
angina Ludovici and parotitis. The most frequent cause is in- 
flammation of the perichondrium of the laryngeal cartilages, in 
consequence of tuberculous, syphilitic, .typhous and carcinoma- 
tous ulcerations. At last we find it in connection with pyaemia 
and septicaemia, with ulcerative endocarditis, typhus, variola, 
scarlatina, measles and erysipelas. 



328 LARYNX AND TRACHEA. 

The inflammatory process may be diffuse, or limited to the ary- 
teno-epiglottidean folds, and is then more marked on one side 
than on the other; it affects the submucous tissue of tbe vocal 
cords alone only . rarely, and exists below the cords still more 
rarely. 

The non-inflammatory form, a simple, serous infiltration of the 
submucosa, or dropsy, is either a part of general dropsy, in con- 
sequence of nephritis, malarial cachexia, amyloid degeneration 
of the kidneys, etc. ; or a dropsical manifestation from diseases of 
the heart, emphysema and cirrhosis of the lungs ; or the result of 
compression of the superior and inferior thyroid, or facial, or in- 
ternal jugular and the innominate veins by enlargement of the 
thyroid gland, or the swelling of the lymphatic and salivary 
glands, or by new formations about the neck, aneurism of the 
aorta, etc. The oedema will be unilateral or bilateral, according 
to the site and extent of the hindrances to the circulation. The 
cedematous parts appear pale or pale red, translucent and flabby; 
the mucous membrane is neither injected nor swollen. By means 
of the laryngoscope, we can best decide the nature of the affection. 

The most prominent symptom of either form is Laryngeal dysp- 
noea, which at first is only inspiratory, while the expiratory stream 
of air passes the larynx without any difficult}-. The reason of 
this is, that during inspiration, the air presses the swollen parts 
around the introitus laryngis together, thus closing its aperture, 
while during expiration the out-rushing air pushes them asunder. 
However, this difference ceases when the infiltration spreads to 
the aryteno-epiglottidean folds, to the epiglottis and the superior 
cords. There is also hoarseness and barking cough. The inten- 
sity of the laryngeal stridor depends always on the grade of 
swelling of the soft parts, and it terminates in suffocation if the 
obstruction can not be relieved. The inflammatory form may 
result in abscesses or ichorization. 

THERAPEUTIC HINTS.— In general I must refer to the various 
causes of this affection above detailed. In special compare : 

Aeon. 

Apis, when it occurs in connection with erysipelas or eruptive 
fevers. 

•Arsen., when in connection with general dropsy, following kid- 
ney diseases, etc., with great restlessness and prostration. 

Aram triph., when in combination with diphtheria or scarlet 
fever. 



PERICHONDRITIS LARYNGEA. 329 

Bellad., sudden attack; fauces deep purple; all the parts of larynx 
oedematously, swollen ; pain deep in throat ; stiff neck ; wild ex- 
pression of eyes ; great prostration. One drop of tincture in pint 
of water, by teaspoonful. (P. J. Valentine.) 

Canthar., when in consequence of burns. 

China, when in connection with dropsy ; inspiration short and 
difficult, expiration easy. 

Laches., when in connection with albuminuria; dark, almost 
black urine, like coffee-grounds. 

Phosphor., in connection with heart-disease. 

Sanguin., tonsils and pharynx swollen ; sawing, rasping respira- 
tion ; expiration easier than inspiration ; cough dry and harsh 
relieved by sitting, aggravated by eating or lying down ; difficult 
expectoration of tough, glairy mucus ; inflammation of cervical 
glands. 1st trit. (Th. Nichol.) 

Swallowing of small pieces of ice has been found beneficial by 
Niemeyer in the' inflammatory form. 

If in bad cases medicine does not quickly relieve, scarifica- 
tion of the swelling must be tried, and if that does not succeed, 
tracheotomy is the only means to prevent suffocation and gain 
time for further medical treatment. 

Perichondritis Laryngea. 

The inflammation of the perichondrium of the laryngeal carti- 
lages is not easily recognized in the beginning, because pain, 
swelling, cough, hoarseness and laryngeal stenosis are symptoms 
of various laryngeal affections. When however the inflammation 
has reached the stage of an abscess which has broken, a diagnosis 
may be more readily formed. The cartilages most liable to be 
affected are the cricoid and the arytenoids. ' If it be the cricoid, the 
swelling will be found on the posterior wall of laryngeal opening, 
or when seated in one of its lateral portions, somewhat towards 
the one or the other side of the posterior wall ; if it be one of the 
arytenoid the swelling will be seen more anteriorly either on the 
right or the left side in the neighborhood of the cartilages of 
Santorini and Wrisberg. 

Thyroidal perichondritis may exist either on its inner surface, 
or penetrate to its outer surface and form a laryngeal fistula. Peri- 
chondritis of the epiglottis is of rare occurrence, usually in con- 
nection with the same process in the cricoid and thyroid cartilages, 
or with other ulcerative 



330 LARYNX AND TRACHEA. 

The Causes of laryngeal perichondritis are various. It may 
arise from traumatic influences, for instance from the frequent 
introduction of the oesophageal sound in old persons; from tuber- 
culous, typhous, syphilitic or cancerous ulcerations; from primary 
laryngeal chondritis. 

THERAPEUTIC HINTS.— All in all the disease being more of a 
secondary nature, the accompanying primary disease will have 
to be studied first; therefore a number of remedies will offer 
themselves for consideration. As acting especially upon the 
cartilage, Von Grauvogl designates Silicea. 

In cases where the abscess closes the larynx, tracheotomy will 
have to be resorted to. 

Phthisis Laryngis, Tubercular Ulceration. 

As a rule, tubercular ulceration of the larynx is secondary to 
pulmonary tuberculosis and co-existing with it; in exceptional 
cases it may precede pulmonary manifestations, at least palpable 
ones. Commencing with slight hoarseness, lack of ring and easy 
giving way of the voice on taking a slight cold, which however 
gradually subsides, the trouble is often overlooked. The laryngo- 
scope shows at this time partial injection and swelling of the vo- 




Extensive Phthisical Ulceration. (After Tiirck.) a, b, c, Remnants of Epiglottis. 

cal processes, of the inter-arytenoid region and the cartilages of 
Santorini. In other cases there is a striking ansemia of the mu- 
cous membrane and not seldom paresis of the muscles. Gradu- 
ally by renewed colds, ulcers form on these places ; they may be 
single, they may spread to the epiglottis and to the ventricular 
bands and vocal cords, and form an extensive ulceration all 
around the glottis. The hoarseness increases, often to total apho- 
nia ; the cough is generally without tone or power, and there is 
usually soreness on swallowing, and burning and stinging pain 
in the region of the larynx. The ulcers of phthisical subjects 



PHTHISIS LARYNGIS 331 

present no characteristic signs by which they could be recognized 
as such, we must consider the whole history of the case (whether 
there be any syphilitic taint) and its present state (co-existing 
pulmonary tuberculosis), in order to form our diagnosis. 

The Prognosis is that of tuberculosis in general, a poor one ; 
still, if the course of the disease is slow, and the frequency of the 
pulse does not, for any length of time, exceed 96 to 100 ; if the 
ulceration is not too extensive and the co-existing tubercles in 
the lungs are not in an extensively softening process, and no new 
infiltrations occur, and also if the patient can and does implicitly 
follow our advice, we surely will be able by a careful study of the 
case to prolong life, at least., 

THERAPEUTIC HINTS.— The treatment of pulmonary tuberculo- 
sis must be studied. For the prominent laryngeal symptoms, 
compare Laryngitis Chronica ; besides consider : 

Arg. nitr., swelling of the parts ; ulcers with luxuriant granula- 
tions; titillation in the larynx; much hawking, or spasmodic 
cough, and accumulation of phlegm. 

Arsen., " dirty red, or anaemic appearance of the laryngeal lin- 
ing, with bluish-red patches, or general discoloration of the tis- 
sues ; indolent, or burning extensive ulceration, with more or 
less sero-purulent secretion. Pulse small and feeble ; progressive 
emaciation and weakness." (Meyhoffer.) 

Bellad., for intercurrent " colds," with difficult and painful de- 
glutition ; spasmodic or barking cough. 

Carb. an., greenish expectoration ; lungs affected, especially right 
side; enlarged glands; copper-colored spots on face and body; 
earthy colored face ; great exhaustion. 

Carb. veg., evening hoarseness; bloatedness ; rancid belching; 
the most innocent food disagrees. Great tendency to perspire 
about the chest and to take cold on least change of temperature ; 
knees always cold but especially at night in bed. 

Podium and Kali bydr., in scrofulous subjects ; follicular swelling 
of throat ; extensive ulceration. 

Laches., ulceration on left side of glottis ; bluish inflammation 
of fauces ; voice and cough .without tone. 

Merc, jod., after Bellad., " dark red inflammation and swelling of 
the parts with much hawking, coughing and purulent expectora- 
tions worse in the morning., (Meyhoffer.) 

Nitr. ac, "great irritation; redness and ulceration of the epi- 



332 LARYNX AND TRACHEA. 

glottis and larynx, with difficult and painful deglutition, violent 
dry cough and nocturnal perspiration." (Meyhoffer.) 

Phosphor., Sepia, Silic, Stramon. and Sulphur, ought not to be 
overlooked. 



Syphilis Laryngis 

May consist of a mere Catarrh, scarcely distinguishable from an 
ordinary catarrh ; or of Condylomata, which are fiat wart-like pa- 
pules, with a thick, whitish gray, adventitious covering of epi- 
thelium; or of Gummy tumors or Syphilomata, consisting of little 
roundish swellings of the size of a pin-head to that of a small 
pea, usually of the color of the rest of the mucous membrane, 
and frequently found in rows ; or of actual Ulcers of various ex- 
tensions and depth. The diagnosis of all these must be made 
from the history of the case, from the evidence of other syphilitic 
affections, especially in the pharynx, on the skin and in the 
bones, and by the laryngoscope. Ulcers may lead to syphilitic 
perichondritis, to bsemorrhages, and papillomata, which often 
form in the vicinity of syphilitic cicatrices. 

THERAPEUTIC HINTS.— Aurum, accompanied by ulcers on the 
roof of the mouth; previous mercurial treatment; affections of 
the bones. 

Merc, sol., when ulcers appear also on the tonsils. 

Merc, jod., painless ulcers. 

Kali hydr., previous mercurial treatment. 

Kali bich., ulcers on the soft parts of the fauces. 

Nitr. ac, painful ulcers; abuse of mercury; condylomata. 

Thuja, condylomata. 

Neoplasms of the Larynx. 

Of these, the Papilloma or Fibroma papiHare occurs most fre- 
quently; it is a proliferation of the connective tissue, commenc- 
ing by preference on the anterior extremities of the vocal cords. 
The Papillomata are in fact hypertrophied papilla?, covered with 
a thick layer of epithelial cells. Their size and form varies, re- 
presenting either little buttons or pegs, or warty formations like 
a cock's comb; in some cases they attain to huge growths simi- 
lar to a berry, grape, or cauliflower, which may partly or entirely 
fill the upper and middle laryngeal cavity. 



NEUROSES OF THE LARYNX. 333 

The Fibroma, or Fibrous polypus is also of frequent occurrence, 
appears mostly single, rarely multiple, takes its origin on the 
vocal cords. It presents itself as a little, generally pedunculated, 
roundish or pear-shaped tumor, of a dirty whitish or reddish, or 
dark red color, sometimes with distinctly branching vessels on 
its surface. Its size may attain to that of a hazel-nut, and its 
consistence is either hard or soft. Fibrous polypi usually are of 
slow growth. 

Mucous polypi and Cystic tumors are of not so frequent occur- 
rence. They take root in the ventricle of Morgagni by prefer- 
ence, being attached to a broad base; they grow slowly and 
seldom attain any considerable size. When incised, they slowly 
empty their more or less thickened contents. 

Carcinoma or Cancer occurs tolerably often within the larynx, 
and especially in its epithelial form. Its seat is almost invari- 
ably the upper and middle portion of the laryngeal cavity. 
Laryngoscopic examination seldom shows very characteristic 
conditions at the beginning, especially in those cases in which 
cancerous infiltration into the submucous tissue produces a uni- 
form intumescence of the soft parts, with strong vascular injec- 
tion of the mucous membrane. Later, however, when the intu- 
mescence becomes considerable and extensive ulceration takes 
place, with enlargment of the lymphatic glands of the neck, and 
an extension of the morbid process to the pharynx or oesophagus, 
its diagnosis is easy enough. 

THERAPEUTIC HINTS.— Usually, that is since the laryngoscope 
has been in use, the neoplasms have been treated surgically 
either by cauterization or by extirpation, or by still more com- 
plicated surgical operations. We are sadly in want of observa- 
tions gained by pure homoeopathic treatment. If it, however, is 
beyond doubt that similar morbid growths on other parts of the 
body have been removed by the administration of homoeopathic 
remedies alone, there is no reason why a similar treatment should 
not succeed in these cases. Compare, for instance, polypi in ears, 
nose, etc. For cancerous disorganization even extirpation is of 
no avail. 

Neuroses of the Larynx. 

These are either neuroses of sensation (anaesthesia, or hyper- 
esthesia, neuralgia of the laryngeal mucous membrane), or of 
motion (paralyses or spasms of certain muscles of the larynx). 



334 LARYNX AND TRACHEA. 

Anaesthesia, or diminution or total extinction of sensibility in 
the laryngeal mucous membrane, is an ordinary symptom of ap- 
proaching death; it occurs in diphtheritic paralysis of the organs 
of the throat, and at times in hysteria. Its degree and extent 
vary, and can only be ascertained by carefully testing the parts 
by the probe under guidance of the laryngeal mirror. 

THERAPEUTIC HINTS.— Argent., Gelsem., Kali brom. Elec- 
tricity. Strichnine. 

Hypersesthesia and Neuralgia occur most frequently in inflam- 
matory and ulcerative conditions of these parts. When it is a 
symptom of general nervousness, as in hysteria, it is frequently 
attended with a spasmodic cough of longer or shorter duration, 
and at times periodically recurring at a given hour. Hypo- 
chondriasis too, especially in persons suffering from seminal 
emissions, is at times attended with great sensitiveness of these 
parts. 

THERAPEUTIC HINTS.— Ignat. meets frequently the hysterical 
cough. Other symptoms must necessarily be taken into con- 
sideration. If in connection with inflammatory conditions, com- 
pare these. 

Paralysis may be bilateral in consequence of a paralysis of the 
trunk of the recurrent of both sides. The recurrent innervates 
all the muscles concerned in the locomotion and tension of the 
vocal cords, except the crico-thyroid muscles. Such a paralysis 
is therefore characterized " by absolute loss of voice ; inability to 
cough or expectorate with force ; undue expenditure of breath 
on making attempts at phonation, or at forcible expiration, for 
instance in coughing; tbe absence of dyspnoea during quiet 
breathing, at least in adults; laryngoscopally, the cadaveric 
(widely opened) position of both vocal cords, the edges of which 
still further approximate each other on forced inspiration." 
(Von Ziemssen.) It may be unilateral when the trunk of the re- 
current of one side only is paralyzed. This causes the voice to 
lose its ring and become impure (rattling), being rendered so 
by tremors ; on straining it in speaking loud, the voice readily 
breaks into a falsetto, and the patient becomes wearied. The 
vocal cord of the paralyzed side remains motionless during pho- 



NEUROSES OF THE LARYNX. 335 

nation, while the healthy cord and arytenoid cartilage pass over 
the median line. When the posterior crico-arytenoid muscles, 
the office of which is that of widening the glottis during respira- 
tion, become paralyzed, the inspiratory opening of the glottis is 
extinguished, and true stenosis of the glottis of the highest grade, 
with danger of asphyxia, is established. The mirror shows the 
glottis transformed into a narrow slit, which is still further nar- 
rowed by the external atmospheric pressure during inspiration, 
while during expiration the glottis returns to its original size. 
Inspiration, therefore, causes loud sounding vibrations of the 
vocal cords, which are pushed forward to the middle, while ex- 
piration takes place unhindered, is short and noiseless. The 
voice seldom undergoes any change. 

Still other individual muscles may be paralyzed, but they are 
of less importance. 

THERAPEUTIC HINTS. — Compare : Bellad., Bryon., Coccul., 
Caustic, Cuprum, Ignat., Plumbum, Zincum. China and Stramon., 
difficult inspiration and easy expiration. Electricity. 

Paralytic or Paretic Aphonia, may require : 

Amm. caust, when attended with bronchial and asthmatic 
symptoms, great general muscular debility, exhaustion and 
tremors. 

Ant. crud., loss of voice from getting heated by exertion ; return 
of voice b}^ resting. 

Arg. met, hoarseness after singing and preaching; anaesthesia 
of the fauces. 

Arum triph., aphonia after singing or speaking; voice changes 
in tone frequently. 

Bellad., aphonia comes on suddenly. 

Caustic, sudden loss of voice after taking cold, often combined 
with catarrhal symptoms. 

Cina, peculiar twitching of the right hand when coughing; 
right side of chest constricted, with difficult breathing; gurgling 
noise down along the oesophagus. (Kafka ) 

Cupr. met, aphonia from central causes after convulsions. 

Gelsem., after diphtheria; during catamenia. 
, Ignat, in hysteria. 

Laches., paralysis of left vocal cord ; worse after sleep ; tender- 
ness to touch. 

Nux mosch., aphonia from walking against the wind; hysterical, 
gastro-intestinal and cardiac derangements. 



336 LARYNX AND TRACHEA. 

Nux vom., coming on suddenly and combined with catarrhal 
symptoms. 

Opium, loss of voice from fright. 
1 Phosphor., vocal cords broad and relaxed; tired; pale; chest 
oppressed ; menses too often. (Welch.) 

Platina, in uterine disturbances. 

Rhus tox., after straining the voice. 

Stramon., from cerebral disease and great mental excitement. 

Sulphur, chronic cases of all kinds. 

Spasm of the Glottis. 

In books this affection has been described under various 
names: Asthma spasmodicum or Laryngeum infantum, Asthma period- 
icum acutum infantile, Laryngimus stridulus, Laryngitis stridulosa. 
The most prevalent, however, and at the same time the most in- 
appropriate names are Asthma Millari and Asthma thymicum Koppii. 
It is quite difficult to understand how the description which Mil- 
lar gives of a certain affection of children, and which he himself 
styles Asthma acutum, could ever have been applied to spasmus 
glottidis, as it portrays quite clearly what we may express by the 
term of Laryngitis. He even recognizes the " white, tough, jelly- 
like stuff," with which the windpipe was found filled after death. 
The term Asthma thymicum Koppii is likewise inadmissible; for 
the assumption which it implies, that these spasmodic fits be 
caused by a swelling or enlargement of the thymus glands has, 
in consequence of late pathologico-anatomical researches, become 
unattainable. 

The Symptoms of spasmus glottidis are as follows: It com- 
mences with slight and short attacks of dyspnoea, attended by a 
wheezing noise during inspiration, whereby the children move 
uneasily and show an anxious expression. Soon all is over; and 
if the attacks happen during the night they may be overlooked 
altogether. By and by, however, these spells increase in number, 
intensity and duration. The child is suddenly attacked in con- 
sequence of a little fright, or whilst crying, laughing, drinking, 
or especially in the moment of getting awake; its inspiration 
becomes whistling, crowing and so difficult that it strains all the 
respiratory muscles to draw the air through the spasmodically 
closed glottis into the lungs. Expiration is quite impossible, and 
thus respiration ceases for a while altogether. The face of the 



SPASM OF THE GLOTTIS. 337 

child expresses the greatest agony and sense of suffocation, and 
becomes purple; cold perspiration appears upon the forehead; 
the veins of the neck become turgescent and the thorax is motion- 
less. The pulse falls at this stage and is small and intermitting. 
This fearful condition lasts in severe cases a minute or two at the 
utmost, generally only a few seconds; then with a loud, crowing 
cry the child again catches its breath, is exhausted, cries and 
sobs, but shows no signs of fever or any catarrhal affection. The 
number of attacks may amount to ten, twenty, even fifty, in the 
course of a day; and if the complaint be not arrested it may ter- 
minate in general convulsions and death. 

The age in which children are attacked by this disease lies, in 
most cases, between their fourth and fourteenth month ; as they 
grow older and stronger, the spells grow milder. In adult* it is 
of rare occurrence, and then much less severe, on account of the 
larynx being more developed at that age. The female sex dur- 
ing the age of puberty, is the most frequently attacked amongst 
grown persons. Its pathological character is a disturbed action 
of the nervus vagus or recurrens, either from central or periph- 
eral irritation. In children rachitis is the principal cause. 
Post-mortem examination shows the larynx entirely free from 
any morbid changes. 

THERAPEUTIC HINTS.— Bellad., congestion to the head; throb- 
bing of carotids; teething process; drinking excites the spasms. 

Bromium, gasping and snuffing for breath. 

Chlorine, (the gas in water) crowing inspiration and expira- 
tion impossible (Dunham). The respiratory acts consist of a 
succession of crowing inspirations, each one followed by an in- 
effectual effort at expiration, the whole serving to inflate the 
chest to a most painful extent. (W. S. Searle.) 

Cuprum, bluishness of face and lips; convulsions; after fright 
of mother or child. Cold perspiration at night; cough relieved 
by a swallow of cold water. 

Gelsem., inspirations long, with crowing sound; expirations 
sudden and forcible. 

Ignat, difficult inspiration with easy expiration; hysteria. 

Iodium, tightness and constriction about the larynx, with sore- 
ness, hoarse voice, etc. Enlargement and induration of the 
glands, cervical and mesenteric; absence of appetite; utter in- 
difference to food; scanty, high colored urine; clayey evacua- 



338 LARYNX AND TRACHEA. 

tions ; emaciation ; yellow skin ; action of heart feeble and much 
increased by motion. (Dunham.) Rachitic children; swelling 
of bronchial glands ; thymus gland (perhaps) enlarged. 

Ipec, blueness of face and coldness of extremities, at the com- 
mencement. 

Laches., sensitiveness of larynx and trachea to the touch. 

Mephii, similar to Chlorine, has suffocating feeling with ina- 
bility to exhale; bloated face and convulsions. (W. S. Searle.) 

Moschus, in hysterical women. 

PhytoL, " frequent spasmodic closure of the larynx ; drawing of 
the thumbs into the palm ; flexion of the toes ; distortion of the 
face; muscles of the eyes affected so that the motions of one eye 
were independent of the other." (Kapp.) 

Plumbum, spasmodic closure of the rima glottidis; mucus rat- 
tling in throat, with sudden difficulty of breathing and asphyxia. 

Sambuc, able to inhale but not .to exhale; becomes livid in 
the face; gasps in great anguish and very slowly recovers its 
breath; awakes from sleep with suffocation. (C. Wesselhoeft.) 
Burning red, hot face, hot body, with cold hands and feet during 
sleep; on awakening, the face and body break out into a profuse 
perspiration, which continues as long as the patient is awake ; 
on falling asleep again, the dry heat returns. 

Veratr., cold perspiration on forehead, and cold extremities. 

The following remedies may also be indicated in individual 
cases : Arsen., Calc. carb. and phosph., Chamom., Corall. rubr. (Mey- 
hoffer), Hydr. ac, Lauroc, Pbospbor., Silic, Spongia, Sulphur. 

The rachitic conditions require : Calc. carb., Hepar, Iodium, Silic., 
Sulphur. 



THORAX. 



This is a chapter of great importance, and at the same time of 
difficulty. Its exploration we will have to undertake on different 
roads. We must know what is to be learned by inspection, pal- 
pation, percussion, and auscultation. 

I. Inspection— Ocular Examination. 

If we consider that the thoracic cavity holds within itself the 
lungs and heart, the organs of respiration, and of circulation, we 
shall understand why it is that the first phenomenon which 
strikes the eye is the continuous motion in which we find its walls 
engaged. 

This Respiratory motion of the chest in men is greatest in the 
region of the lower ribs on each side ; in women, on the upper 
part of the chest ; and in children, towards the abdomen. 

The number of respirations varies according to age, sex, and 
individuality ; so that we might put down the normal number 
of respirations per minute in grown people at from twelve to 
twenty; in young persons, from fourteen to twenty-four; in 
children, about twenty-six, and in infants about forty-four. But 
there are other conditions which may materially modify the fre- 
quency of respirations — such as mental excitement, bodily 
exertions, digestion, temperature, and other conditions of the air. 
As a rule, however, if compared with the pulsations of the heart, 
it may be said, that during one respiratory act there are three 
or four beats of the heart ; but these respiratory motions of the 
lungs and pulsations of the heart never correspond in rhythm, as 
you may easily ascertain by counting your pulse, and observing 
your breathing at the same time, the pulse being a little too fast 
or a little too slow to make up an even count between respiration 



340 THORAX. 

and pulsation. This is a very interesting fact, which it is well to 
hear in mind. When respiration and pulsation become synchro- 
nous — that is, when upon each act of respiration for a length of 
time fall precisely two, three, four, five, or six pulsations — we 
may be pretty sure that death is near. My attention was first 
drawn to this interesting fact by Dr. Hering. Since then I have 
found it verified many times. Its explanation is another matter. 
We might, perhaps, explain it, if we remember that the heart's 
action is governed mainly by the sympathetic nerve, while the 
lungs are under the control of the vagus, though each of them 
sends branches to the other organ, the sympathetic to the lungs, 
and the vagus to the heart. The sympatheticus is the great nerve 
of organic life, and under its direction all the functions of the 
body are performed, which are entirely out of the reach of the 
will. It arises from a series of ganglia, extending along each 
side of the vertebral column from the head to the coccyx. The 
vagus has its origin in the brain, and its fibres may be traced 
through the fasciculi of the corpus restiforme into the gray sub- 
stance of the floor of the fourth ventricle, and therefore the parts 
to which it is distributed are more or less under the control of 
the will. When death approaches, or, in other words, when the 
separation of soul and body commences, those functions which 
are more or less under the control of the will are most probably 
the first to cease. The vagus losing its influence upon the lungs, 
their action is now continued under the sole direction of the 
sympatheticus as long as organic or vegetative life still continues; 
thus respiration and pulsation act in full harmony — become per- 
fectly synchronous. 

" The respiratory motion of the chest itself in ordinary health 
is comparatively slight, in consequence of the thoracic cavity be- 
ing enlarged in every direction nearly simultaneously. It re- 
sembles the easy ebb and flood of a soft wave. When, however, 
a deep respiration is taken, it is observed that the sternum is 
slightly but steadily projected forward, the abdominal parietes 
gently dilated. The lower ribs are first and most considerably 
raised, and the elevation of each separate rib takes place gradu- 
ally, evenly, and regularly upwards, notwithstanding which, 
each and all appear to move at the same time. Every part acts 
separately, but each in perfect harmony with the other." (H. M. 
Hughes.) 

Without any deviation in form, a remarkable stillness and 



INSPECTION — OCULAR EXAMINATION. 341 

want of movement may be observed either of a whole side or 
only a part of it. This is a sign of inflammation of the pleura in 
its early stage. 

The thoracic breathing, when the diaphragm is not moved, is a 
sign of peritonitis; the abdominal breathing, when the ribs are not 
moved, is a sign either of inflammation of the chest, or of para- 
lysis of the respiratory nerves, except the phrenic, from injury of 
the upper part of the spinal cord. 

The Form of the thorax must also be taken into consideration, 
and this must always be done by comparing one side with the 
other. In this way, if we bear in mind the natural motion and 
the natural shape of the thorax, ocular inspection will reveal the 
following noticeable facts : 

1. The upper ribs sink away from the clavicle, become flat- 
tened and motionless, while, in many cases, the movement of the 
lower ones is not interfered with, and, as. a general rule, the 
change is more evident on one side than on the other. This is a ' 
sign of advanced phtlnsis. (Barclay.) 

2. The chest is full and rounded ; the ribs stand out, but have 
a very slight range of movement, and the inspiratory effort is 
marked by powerful traction of the muscles of the neck ; the 
movement of the lower part of the chest is very often inward in 
place of outward, during inspiration. (Barclay.) These are some 
of the physical signs of emphysema of the lungs, that morbid state 
in which the volume of the organ is increased in consequence 
either of the dilatation of the air-cells, or, what is of rarer Ocur- 
rence, of the escape, of air into the space between the lobules or 
beneath the pleura ; and also of croup. 

3. Only one side bulges, the intercostal spaces are obliterated 
and the respiratory motion is annihilated. This is a sign of a 
collection of serum — hydrothorax, or of pus — pyothorax, or of gas 
— pneumothorax — into the pleural sac. 

" But in many advanced cases of pleuritic effusion, of empyema 
(collection of pus) and of pneumothorax, with effusion, not only, 
as before stated, is the side not enlarged, but it is, on the contrary, 
contracted ; and not only are the intercostal spaces not widened 
and prominent, but they are actually much narrowed. Herein 
exists a notable example of that which is so necessary to bear 
constantly in mind, that the results of one mode should be care- 
fully compared with those deduced from other modes of physical 
examination, and the whole weighed together with the observa- 



342 THORAX. 

tions derived from the history and the constitutional symptoms 
of the case under examination. Because the side is contracted, 
and the intercostal spaces narrowed, as observed upon inspection, 
it might be hastily assumed that there was no fluid in the chest, 
while in truth the contracted side might be actually filled with 
pus or serum, and the other, supposed from its greater size to be 
the one diseased, might be quite healthy." (H. M. Hughes.) 

4. A general fulness or roundness of the precordial region may 
be sometimes observed. This is the case when the heart has been 
enlarged for a considerable time, or when fluid effusion has long 
existed in the pericardium. Nota bene: A broken rib may bulge 
out too! 



II. Palpation— Manual Examination. 

This is a method of using the hand with its sense of touch, for 
the elimination of certain conditions of the thorax. We may 
merely tap with one finger, or lay the whole hand upon the parts 
to be examined, press or glide gently over the surface, according 
to the requirements of the case. In this way we become cogni- 
zant of temperature, form, resistance and motion of these parts. 

The Temperature, if raised to color mordax, fairly burns and 
stings the examining hand, and is found on the chest in far ad- 
vanced pulmonary complaints. We feel at the same time the 
condition of the skin, whether it be dry or moist, harsh or soft. 

The Form. AVhen it is convenient to expose the chest of a pa- 
tient, the appressed fingers of one hand placed flatly and pressed 
firmly upon the infra-clavicular region of one side, while the 
other is similarly placed and pressed upon the corresponding re- 
gion of the other side, are often capable of distinctly appreciating 
a flatness of one side, or a difference in the pliability or expansi- 
bility of the two sides, even in the early stages of phthisis. 

The Resistance depends upon the character of the parieties and 
the contents of the thorax. The resistance of the parieties is 
greater, the more convex, stiff and strong the thoracic bones, 
and the narrower the intercostal spaces are. It is more yielding 
where the contrary conditions exist. In the acromial region the 
resistance to pressure increases when the muscles are put upon the 
stretch. The resistance of the contents of the thorax increases in 
the ratio as they are compressed. Whether there be much or little 
air, water or pus collected in the cavity, it has no influence upon 



PALPATION — MANUAL EXAMINATION. 343 

its resistance to external pressure. But when this air, water or 
pus becomes compressed, and in consequence the walls which con- 
tain it are put upon the stretch, its resistance increases in the 
same ratio, and such swelling within the chest may feel as hard 
as a stone. Hepatization of the lungs gives a considerable resist- 
ance, but it is greater in exudations under the above-mentioned 
conditions. 

Palpation lastly reveals different kinds of Motions which origi- 
nate within the cavity of the chest. The most important of them 
is the Vibration of voice, or the Vocal fremitus, of which we become 
cognizant by placing our hand upon the thorax of a person who 
is in the act of talking or singing. Its force corresponds with 
the power and depth of the voice, so that we feel it much 
stronger in men of a deep base voice than in other persons, 
whose voices are of a higher pitch. Singing and screaming 
causes fremitus even in the highest-toned voice. The localities in 
which it is perceived, arranged according to the strength of the 
vibration, are as follows : 

1. Larynx and trachea down to the sternum in front and laterally. 

2. The last four cervical and first three dorsal vertehrse of the adja- 
cent portions between the scapulas, especially in thin persons and 
children. 

3. Tlie acromial and subclavian regions down to the liver and spleen, 
on the right side much stronger than on the left. 

4. The lateral regions, from the axillse down to liver and spleen; to 
the fifth rib stronger on the right side; below the fifth rib stronger 
on the left side. 

5. The posterior inferior regions from the edges of the shoulder- 
blades downwards. 

6. The shoulder-blade region. 

7. The manubrium sterni, 

8. Where the liver or the enlarged heart or spleen lie close to the 
thoracic tvall, the fremitus is not felt at all. 

The mammas of women decrease the vibration of the voice, 
but do not suppress it altogether. In thin persons with a long 
thorax, the fremitus is stronger than in persons with a broad but 
short thorax. It is felt more in the horizontal than in the upright 
position. This is its normal condition in health. 

In disease it may be increased or decreased. 

It is Increased when the bronchial walls become thickened by 
chronic inflammation ; or when the lungs become hepatized, or 



344 THORAX. 

infiltrated with tubercles, or indurated and consolidated. It is 
also increased by cavities, which lie near the periphery, contain 
air and not much fluid, and which are surrounded by walls of 
good conducting quality; in short, its increase depends upon good 
conductors of vibratory motions. 

The Fremitus is decreased by the presence of large abscesses or 
gangrenous destruction or softening of the substance of the lungs ; 
it is decreased or even suppressed when gas or serum fills the 
pleural sac; and it is decreased when the bronchial tubes are 
filled with mucus, pus or blood; in short, in all cases where the 
vibratory undulation has to pass through different media, air, fluids 
and solids. 

For here, too, is the physical law of the conduction of sounds 
applicable ; the m,ore equal the media in respect to density and elastic- 
ity, the better do they conduct sounds; the greater their inequality of 
substance, the less is their conductive power. 

Another vibratory motion within the cavity of the chest, which 
manifests itself to manual examination, is, the Ronchus vibration, 
caused by tough mucus lodged in the larynx, trachea or bronchial 
tubes, and brought into vibratory motion by the in-going and 
out-going current of air. This vibration very often extends over 
the whole chest, although only a little tough phlegm may be 
the cause of it, which can be thrown off by a single cough. 

When, however, the cause of this vibration consists of phlegm 
lodged in the bronchial tubes, the rhonchus vibration is not felt 
in the trachea and larynx, but may extend all the way down to 
the bronchial periphery. For this reason we can never judge 
from the extension of the vibration to the extension of its cause; 
in other words, it does not follow that because we feel the rhon- 
chus fremitus all over the chest, that there should be phlegm all 
through the chest. This would be a mistake which could be 
made only by those who do not understand the propagation of 
rhonchus vibration. 

A third vibratory motion, recognizable by manual examination, 
is the Peculiar rubbing or grating feel, which occurs when the sur- 
face of the pleura pulmonalis and costalis — which naturally glide 
smoothly upon each other — are roughened by solid effusion be- 
tween their contiguous surfaces, as in pleurisy. It is mostly of 
short duration, but may last in some cases months, and even 
years. The same motion is caused by fibrous deposits within the 
pericardium, in consequence of pericarditis; it resembles very 
much the purring of a cat. 



PALPATION — MANUAL EXAMINATION. 345 

A fourth motion which the examining hand discovers upon the 
thoracic walls are the Pulsations of the heart. " While the body is 
erect, the heart, when in a natural condition, is constantly felt to 
strike the parietes between the fourth and fifth ribs about an inch 
below and to the inner side of the nipple. While lying upon the 
back, its impulse is greatly decreased, and is usually felt some- 
what nearer to the sternum. When the body is turned to the left 
side, the impulse is felt in a direct line with, or often nearly an 
inch to the outer side of a line passing vertically over the nipple; 
while, on the contrary, when the body is turned to the right side, 
it is felt between the cartilages of the ribs, close to the sternum, 
or sometimes cannot be felt at all. 

" When the parietes of the heart are thickened, or hypertrophied, 
and the force of its impulse is consequently increased, the hand, 
placed over the precordial region, becomes at once sensible of its 
abnormal force, though the pulse at the wrist may at the very 
same time be small and feeble. In considerable hypertrophy of 
the left ventricle the apex of the heart strikes not only lower, but 
also outside, or to the left of the nipple line. 

" When the cavities of the heart are dilated, with or without 
any increase of the thickness of their walls, the impulse is often 
perceptibly extended over a larger space than natural, and may 
be felt not only above, below, and around its ordinary site, but 
also in the scrobiculus cordis; and sometimes even on the right 
of the sternum. It must, however, be recollected, that in nervous 
and excitable persons of spare habit, the impulse of the heart is 
often very extensively diffused, even when no disease of the heart 
exists; and, therefore, that a widely-extended or diffused impulse 
is by no means a proof of the existence of disease in the heart, 
or in any other organ. 

"When the heart is removed from its natural situation by 
gaseous or fluid effusions into the pleura, by tumors, abscesses, 
etc., it is by manual examination that the fact can generally be 
best determined. 

"When obstruction exists in the valves, a trembling motion or 
'purring tremor' is frequently communicated to the hand, and 
the tumultuous action, or trembling motion, existing in the more 
advanced stages of disease in the heart, can often be best appre- 
ciated by palpation." (H. M. Hughes.) 



III. Percussion. 

A casual examination of the different works on this subject is 
amply sufficient to cause total confusion in the mind of the be- 
ginner, and a loathing of the task of wading through such con- 
tradictory assertions of the different authors. For whilst the one 
pretends to hear the grass grow, and to find out every little nook 
and hook in the lungs, if wrong, by knocking, another asserts 
coolly, that such talk is a mere flatulent phraseology, referring 
simply to the fact that the most skilled and experienced in this 
knocking art themselves confess of having made the most glori- 
ous mistakes. 

What are we to do then in such perplexity ? Shall we throw 
the whole overboard, as a fashionable craziness of the profession? 
It would be a short process of getting rid of the trouble. But 
then, that is not the thing. There has been so much labor and 
ingenuity bestowed upon this subject, that there must be some 
guiding truths in this heap of collected experiments and re- 
searches, no matter how badly mixed with contradictory asser- 
tions. 

In the following pages I shall try to state the fundamental 
principles, by which we must be guided in the application of this 
kind of examination. 

There is an immediate and a mediate mode of percussion. It is 
immediate when the finger of the examiner strikes directly upon 
the parietes of the chest. It is mediate when some solid material, 
such as a disc of wood or ivory, a piece of leather, or the finger 
of the left hand, is interposed between the parietes and the strik- 
ing body. 

The striking body may be one or more fingers pressed together 
and bent slightly , or a little steel hammer, whose head or strik- 
ing surface is covered with leather or caoutchouc. 

In regard to the merits of these different modes I have to say 
that much depends upon what we may have got accustomed to ; 
still the one or the other may be preferable under certain circum- 
stances, which practice will soon teach. 

What does percussion reveal f 

If we strike different things we receive different sounds. There 
is, however, a marked difference between those bodies which con- 
tain air and such as do not. As extreme examples of this differ- 
ence we may cite the sounds which we obtain when we percuss 



PERCUSSION. 347 

the chest or stomach, and when we percuss the thigh. In the first 
case we obtain a sound which reverberates, — has resonance; whilst 
in the other case we hear a mere noise, a clap, without any re- 
sonance or tone whatever. This latter, which we may call the 
dull, dead or fleshy sound, is everywhere the same, where we strike 
upon an organ not containing air; such as the liver, the spleen, 
the kidneys, hepatized lung, or lung completely deprived of air 
by compression and fluids ; a hard liver yields the same sound 
as a soft liver, a hard spleen as a soft spleen. 

But it is different with such organs and bodies as contain air; 
there the sound varies quite considerably. Take for example an 
open jar or bottle, and percuss it at its mouth, you will hear a 
sound similar to that of a drum ; this is the sound which Skoda 
has called the Tympanitic sound, and which we also might call 
drum sound. Its variations are as follows : 

1. If we percuss an open jar or bottle, this drum sound will 
be deeper, the higher or longer the bottle or the column of air 
which it contains ; it will be higher, the shorter the column of air 
is within. 

2. If we percuss an open jar or bottle, we find that the wider 
the mouth of the vessel, the higher is its tympanitic tone; and, 
the more we contract the mouth of the vessel, the deeper becomes 
this tone. In short, it depends on the volume of air which is 
set into vibration ; a larger volume gives a deeper, a smaller gives 
a higher tone. 

3. If we, however, percuss closed cavities, there comes into con- 
sideration another momentum. A drum or jar, whose mouth is 
closed tightly with a piece of bladder, can exemplify it. We 
perceive at once that the tenser the skin is drawn over the drum 
or the bladder over the jar, the higher becomes its tympanitic 
tone, and vice versa, the looser, the deeper. Here, however, it must 
be remarked, that this comes to pass only when the surrounding 
air and the air within, is of equal density and expansion. As 
sooii as either is set out of that equilibrium, just as soon the tym- 
panitic sound is lost, because this diversity hinders the regular 
vibrations of the membrane, which are necessary for the tym- 
panitic sound. 

Thus we find that the tympanitic sound varies in height and 
depth of its tone. It becomes higher in the ratio — 

1. That the column of the percussed air is shorter ; 

2. That the mouth or aperture by which the percussed air 
ands in connection with the external air is wider ; and 



348 THORAX. 

3. That the enclosing membrane is drawn tensely over the 
cavity. 

It becomes deeper in the same ratio — 

1. That the column of the percussed air is longer; 

2. That the mouth or aperture by which the percussed air is in 
contact with the external air is narrower ; and 

3. That the membrane which closes the vessel is looser. 
Applying these physical rules to the living organism, we come 

to the following results : 

1. The tympanitic sound is heard at the larynx. The wider the 
person under examination opens his mouth, the higher is its tone ; 
in closing the mouth it becomes deeper and weaker, and when 
closing the nostrils also, it becomes still deeper and weaker. 

2. The tympanitic sound is heard where there exist superficial cav- 
ities in the lungs which contain air. If it happens that such cav- 
ities are in immediate connection with the trachea, larynx and 
mouth, by means of large bronchial tubes, then Ave have the same 
phenomena in opening and shutting the mouth, as above de- 
tailed. In opening the mouth the tympanitic sound has a higher, 
and, when shutting it, a deeper tone. If the cavity is in no such 
connection, then opening or shutting the mouth does not alter 
the tympanitic sound. 

3. It is heard on the thorax in all those conditions of the lungs in 
which the external air presses equally strong within upon the substance 
of the lungs, by means of its air-cells and bronchial tubes, as it does 
from the outside upon the thorax; that is, where there is a perfect 
equilibrium between the pressure of the internal and extcmed air. 
This, however, in a normal state is never the case. The inner 
pressure of the air is like the external, minus the contractility of the 
pulmonary tissue. But disease may deprive the lung-tissue of this 
elasticity and contractility by compressing it, whereby this equi- 
librium becomes established. This, we find, for example, in par- 
tial emphysema, in the neighborhood of infiltration, as happens 
in pneumonia, where, not unfrequently, the tissue around the 
hepatized portion, and especially at the borders of the lung, is 
emphysematous, and also during pneumonia, as long as the air- 
cells are not infiltrated, but have lost their natural elasticity. In 
these conditions, we hear a decided tympanitic sound, whilst in 
pneumothorax — a collection of air or gas in the pleural sac — we 
hear none. Especially is this the case when the thorax is much 
distended ; although we might be inclined to expect it more then, 



PERCUSSION. 349 

than under other conditions. We hear it again distinctly and 
invariably at the upper portion of the chest, when the lower-portion of 
a lung is entirely compressed by a pleuritic effusion and its upper 
portion is reduced in volume. 

4. The tympanitic sound is heard lastly in those parts of the ch est 
in whose neighborhood the stomach lies, namely, in the lower part 
of the left mammary, left lateral, and left infra-scapular regions, 
provided the stomach be not too much distended with air; because 
otherwise a regular vibration of its walls, and hence the tympa- 
nitic sound, would be impossible. 

The same is true of the abdomen ; and thus we come directly 
to the following result : The tympanitic sound on percussion is heard 
at the larynx; at the collapsed or compressed lungs; at the relaxed 
stomach, and at the compressible abdominal walls. 

Quite different from this tympanitic sound is another sound 
elicited by the percussion of bodies containing air : the Non-tym- 
panitic sound of Skoda, which we might perhaps more intelligibly 
call the resonant sound of the lungs, or, by abbreviation, the lung- 
sound. The best example of this sound is obtained by percussing 
a healthy thorax ; and, in doing this, we perceive at once that 
there are different degrees of resonance in it. It varies in clear- 
ness from a very resonant to a muffled sound ; and, in duration, 
from a long resonance to a short snap. 

In the normal state of the lungs we find this sound very resonant 
in the superior sternal, the axillary, and the upper part of the 
infra-scapular regions ; resonant in the subclavian, the upper part 
of the mammary, and lateral, and inter-scapular regions; muffled 
in the acromial, and the lower part of the right mammary, and 
lateral, infra-scapular, and scapular regions ; dull, dead, fleshy in 
the inner edge of the left mammary (where the heart lies), and 
in the regions of the liver, spleen, and kidneys. 

Pathological altered states of the lungs alter also this natural 
resonance of the percussion sound. 

It is Muffled, dull— 

1. On any portion of the lung which is deprived of air, if it is, 
at least, the size of a half-dollar, and about half an inch in thick- 
ness. 

2. In the subclavian regions from tubercular infiltration. 

3. In the inferior posterior regions, as the favorite seat of pneu- 
monic hepatization; other parts not excluded from the same 
cause. 



350 THORAX. 

4. Diffused over a considerable portion of the chest in haemor- 
rhages and destructive processes within the substance of the lungs. 

5. In malignant diseases of the lungs, where the pulmonary- 
tissue is pushed aside and the air is excluded from the parts 
affected by cancerous or fungous growth. 

Diseases of the pleura cause a dull percussion sound — 

1. "In pleuritic effusion, no matter whether the fluid be blood, 
serum or pus. The dulness in either case may, and generally 
does, primarily, affect only the lower part of the serous cavity, 
gradually extending upwards as the fluid increases, and by its 
increment displacing the lung. But it may also, on the contrary, 
in either case, extend over only a limited space, to which it is 
confined by previously existing pleuritic adhesions. 

" When the pleura is free from such adhesions, the fluid, from 
whatever part of the membrane it proceeds, may in each case 
gravitate to the lowest part of the cavity, and its site may be 
changed according to the varying position of the patient's body. 
In each case, therefore, the part in which the dulness is observed 
may also vary with the change of position. This change in the 
situation of the fluid and of the consequent dulness, according to 
the position of the body, is, however, far more common in hydro- 
thorax than in either simple pleuritic effusion or empyema, in 
which diseases the fluid is much more frequently confined to a 
limited space by surrounding adhesions, or gravitates with less 
facility." (H. M. Hughes.) 

2. " In malignant disease of the pleura, as in that of the lung, the 
pulmonary tissue is pushed aside, and dulness and resistance ex- 
ist on percussion commensurate with the extent of the solid de- 
posit." (H. M. Hughes.) 

The Metallic ringing percussion sound. This is the same sound 
which we elicit by striking empty or nearly empty vessels. The 
presence of water is not required, but does not hinder its produc- 
tion. According to Wintrich it originates in smooth cavities, 
where the vibrations of the sound are reflected from wall to wall 
in a regular manner. It is heard in pneumothorax, over large 
cavities, and such cavities as are connected with each other, 
whose walls must be fit for the reflection of sound ; that is, they 
must be smooth and curved. 

The Cracked pot sound is similar to the metallic ringing sound, 
only not so perfect — a spoiled metallic ringing. It may be pro- 
duced on any healthy chest by knocking forcibly with the fist 



AUSCULTATION. 351 

against the sternum during loud speaking or singing. It is said 
to be found where cavities exist, but Wintrich says: "It is rather 
a feeling of disappointment for the physician, when he stands by 
the deceased body of a patient during whose illness he many a 
time observed this sign and diagnosticated a cavity in his lungs, 
and yet does not find now any thing the like." For this reason 
we cannot attach a pathognomic meaning to this sound, as it ex- 
presses only general physical conditions. 

IV. Auscultation. 

You may auscultate a patient either by applying your ear im- 
mediately to his chest, or by interposing a stethoscope between it 
and your ear. The first is called immediate and the latter mediate 
auscultation. 

Much has been said in books about the superiority of each 
method over the other; but there is no need of such long dis- 
quisitions. I hear best with the naked ear, and so will any one 
else who faithfully tries both methods. But I prefer the stetho- 
scope decidedly, if I have to examine an unclean person, or a 
person with skin disease, or in cases where great delicacy must 
be observed, or when I cannot easily apply my ear to the parts 
to be examined. 

There has also been a great talk in books about the form and 
material of the stethoscope. It is all the same, whether it be 
made a little shorter or longer, straight or bent, out of one piece 
or of several pieces of wood or metal, if only its bore be smooth 
and adapted to conduct and reflect the sound perfectly. That is 
all that is required. 

In order to know any thing about abnormal sounds in the re- 
spiratory organs, we must first become acquainted with those 
sounds which we can hear in a normal state of these organs. 

The Normal Sounds of Respiration. 

They must be distinctly considered as inspiratory and expiratory 
sounds. 

The Inspiratory sound heard at the larynx, trachea and large 
bronchial tubes may be imitated by forcing air against the hard 
palate, as is done involuntarily in hard breathing, or in pro- 
nouncing the guttural consonant ch. The height or depth of 



352 THORAX. 

this sound (its pitch) depends upon the width of the opening 
through which the air passes. This sound is called Bronchial re- 
spiration or Tubnlar breathing, and is found in a normal state at 
the larynx, trachea, large bronchial tubes under the upper part 
of the sternum, the inner side of the subclavian, the inter-scapular 
regions, and occasionally, though less distinctly, in the axillary 
regions, especially the right one. It is loudest in the larynx, less 
loud at the trachea, and still less loud at the superficial bronchial 
tubes, sounding as if coming from a distance. If this bronchial 
or tubular breathing be heard in other localities than the above- 
named, it may, with tolerable certainty, be regarded as morbid. 
An altogether different sound is heard daring inspiration, when 
we put the stethoscope upon any other part of the chest than 
those previously specified. It may be imitated by narrowing the 
opening of the mouth and then drawing in the air. The conso- 
nant of this murmur is v or b, and • it is called the Respiratory or 
Vesicular murmur of the air-cells and finer bronchial tubes. 

" It varies considerably in intensity in different regions of the 
chest. It is most distinct in the acromial, the central and lower part 
of the superior sternal, the subclavian, the axillary and the subscapular 
regions. It is less distinct in the lateral, the right mammary, the 
scapular regions, still less in the hypochondriac, and least of all 
in the inferior sternal and the inner part of the left mammary 
region. 

"Independently of the variation of the intensity of the sound 
in the different regions of the chest, whether the variation arise 
from the position of the organs, the amount of pulmonary tissue 
beneath the ear, or the facility or difficulty with which the in- 
spired air reaches the pulmonary cells, the two sides of the chest 
frequently vary a little in respect to the loudness of the respira- 
tory murmur. Thus it is rather louder in the acromial, scapular 
and infra-clavicular regions of the right side, but in so slight a 
degree as to be scarcely worthy of consideration in a practical 
point of view. 

"The respiratory murmur may, both locally and generally, be 
more or less loud than natural in persons who are quite free from 
any appreciable disease. It may also be harsh or rough, scarcely 
audible, or altogether absent, Thus, in childhood and in youth, 
the respiratory murmur is louder than in adult life, and espe- 
cially than in old age. From this circumstance a loud inspira- 
tory murmur is called (w r hether normal, as in childhood, or 



THE NORMAL SOUNDS OF RESPIRATION. 353 

youth, or abnormal, from any cause, in age) puerile or supplemen- 
tary respiration: puerile, because it is the normal state of respira- 
tion in children, and supplementary, because it is thought that 
when one lung or a part of a lung is disabled, the increased ac- 
tivity of the other lung, or another part of the same lung, supplies 
the defective action of the diseased organ or part. 

"It is always heard when the healthy respiration is more than 
ordinarily active, as in persons 'out of breath,' as it is called, 
from strong exertion, as running, dancing, etc., or after the res- 
piration has been voluntarily suspended for a time, and the in- 
dividual breathes quickly to restore the normal balance of the 
circulation through the pulmonary organs; we hear it, therefore, 
also after the sudden termination of an asthmatic paroxysm. 
The strength of the inspiratory murmur, instead of being in- 
creased, may be diminished, -though no disease exist in the chest. 
This imperfection of the respiratory murmur is usually observed 
either in parts of the lungs which have been little used, as in the 
lower regions of the chest of females accustomed to tight lacing, 
or in persons suffering from deformity, whether congenital or 
acquired; or in the chest of persons considerably advanced in 
life, also after long illness when the patient for a long time has 
been obliged to lie on his back. In the first two and last in- 
stances the defect results from want of use and consequent imper- 
fect expansion of the lung. In the case of deformity it proceeds 
from atrophy and consequent defective functional activity of the 
pulmonary tissue. It may, indeed, be regarded as the natural 
character of the respiratory sound in old people, and may there- 
fore be called 'senile,' as that existing in children is termed 
'puerile respiration.' 

" Occasionally the inspiratory murmur is entirely absent from 
one or a part of one lung, though no disease be present in the 
organ itself. This condition, however, probably never exists 
without some mechanical obstruction to the ingress of air, either 
in the air-tubes or upon the exterior of the organ (spasm, foreign 
body, apparent death)." (H. M. Hughes.) 

The murmur of expiration in the normal state of the respiratory 
organ causes little or no sound in the air-cells and finer bronchial 
tubes; whatever sound is heard differs from the murmur of in- 
spiration, and resembles rather a gentle aspiration or blowing. 
It can be imitated only by the mouth during expiration; the 
23 



354 THORAX. 

consonant which represents it falls between/ and h. In the lar- 
ynx, however, it is louder than the inspiratory murmur. 

Laennec and Skoda attribute the sound of the vesicular breath- 
ing to the friction of the air against the walls of the finer bron- 
chial tubes and the air-cells, the contractile power of which it has 
to overcome. The reason why the inspiratory murmur of the 
air-cells is much louder than the expiratory is, that the air, when 
it enters into them, meets with resistance from their contracti- 
bility, but does not meet with any in its passage out of them. It 
is otherwise, however, with tbe large bronchial tubes, and partic- 
ularly with the trachea and larynx ; here the air, during inspira- 
tion, meets with no opposition ; it has, indeed, rather a tendency 
to expansion; but during expiration the stream of air coming 
from all parts of the lung out of the air-cells, collecting in the 
trachea and larynx, becomes compressed and causes friction on 
the walls of this tube, and especially in the narrow glottis; hence, 
the expiratory murmur of tbe larynx, trachea and large bronchi is, 
as a rule, louder than the inspiratory. 

Pathological Deviations from the Normal Vesicular Respiration. 

1. The inspiratory murmur. The presence of the vesicular mur- 
mur at any part of the thorax indicates tbe entrance of air into 
the air-cells of that part of the lung which lies beneath the spot 
auscultated. Its absence, therefore, indicates those abnormal con- 
ditions which prevent the passage of air into the air-cells; such 
are compression of the air-oils by exudations or tumors in the 
pleura; by enlargement of the heart and other diseases: in tilt ra- 
tion of the lung tissue by plastic or tuberculous matter, by blood, 
serum, pus, etc.; atropliy of the air-ceils and obstruction of the bron- 
chial tubes by mucus, blood, or by swelling of the mucous 
membrane. 

The vesicular murmur becomes harsher, when the lining mem- 
brane of the air-cells and finer bronchial tubes is rough- 
ened, swollen, and thickened. The presence of a harslt vesicular 
respiration, which may amount sometimes even to a hissing 
sound, indicates, therefore, a swelling of the mucous membrane of 
the finer bronchial tubes and air-cells, as exists in catarrh; or soli- 
tary tubercles thickly scattered through the tissue of the lungs: and 
oedema of the lungs. 

2. The expiratory murmur. In a healthy condition of the lungs 



AUSCULTATION. 355 

it is very soft and somewhat shorter than the inspiratory mur- 
mur, sometimes scarcely audible. Its abnormal conditions are, 
therefore, harshness and prolongation. The causes hereof must be 
sought in a roughened and narrowed condition of the finer bron- 
chial tubes and air-cell§, by which greater friction of the egress- 
ing air is produced. 

This prolongated and harsh expiratory murmur is rarely heard 
extending all over the lungs in a uniform manner, but is mostly 
confined to portions of the lungs, and then is of the highest diag- 
nostical importance. 

If it extends over a large surface of the lungs, it indicates a ' 
more generally swollen and uneven surface of the bronchial mu- 
cous membrane ; as we find in acute and bronchial catarrh, with 
or without emphysema. If it, however, is confined to the apex of 
the lungs, between the first and third ribs, and more in front 
than behind, and more on one side than on the other, it indicates 
tuberculosis. 

Dr. Jackson, of Philadelphia, was the first who, in the year 
1832, drew attention to this prolonged, harsh, and partial expira- 
tory murmur, as a sign of tubercular infiltration, and it has been 
confirmed by a number of authors since. 

This prolonged, expiratory murmur is sometimes broken into 
two or three jerks, and is observed in tuberculosis ; also in old 
people and children when frightened ; also during the chilly 
stage of fevers. The inspiratory murmur also exhibits such in- 
terruptions. It is necessary to listen in such cases to the larynx, 
whether the interruption is heard there too, otherwise it might 
easily be mistaken for a friction-sound of the pleura. 

3. Bronchial respiration. When we auscultate the larynx or 
trachea, the respiratory sound is louder than in any other part 
of the chest, if it be in a healthy condition. It may be imitated, 
as said before, by forcing the air against the hard palate, so as to 
produce the consonant ch, guttural. This respiratory sound has 
been termed bronchial respiration. If heard in any other part 
than that above specified, it denotes a change in structure, which 
subdues the vesicular breathing, and serves as a good conductor 
of sound from the larger bronchial tubes. Such conditions are: 
hepatization and tubercular infiltration (the most frequent) ; next in 
frequency, thickening of the bronchial tubes, with atrophy of the lung 
tissue; pulmonary oedema and pleuritic effusions; and hydrothorax. 

4. Rhonchi or rattling noises in the respiratory organs. When the 



356 THORAX. 

bronchial tubes are partly constricted, or when tough mucus ex- 
ists therein, which is set into a vibratory motion by the rush of 
air during respiration, or, if sticking tightly to the walls, is sud- 
denly torn, then we have all sorts of noises within the thorax. 
Such noises may sound high, deep, clea^ husky, harsh, or hol- 
low; may be short like a snap, and return at intervals: or be 
continuous for a longer time, like the purring of a cat. 

"These noises," says Dr. Wintrich, "have been called, funny 
enough, dry rattle noises, and have been divided into rhonchi 
sicci, graves, sonori, sibilantes and canori. The poetical talent 
of some authors has had ample opportunity to force them by 
comparison into the most singular and fanciful classes, by which 
a cool reflection has mighty little to think," and, I may add, by 
which the beginner is thrown into utter confusion. They origi- 
nate within the respiratory tubes, exactly in the same manner as 
sounds originate in any other kind of tubes. The sound is high, 
shrill, when the tube is narrow or constricted in one or more 
places; it is deep, when the vibrating column of air is long, or 
when the vibratory undulation is slow; it is loud, strong, when 
the stream of air is of great force; and rice verm, it is weak, faint 
when the stream of air is weak. 

These ronchi often extend over a large portion of the chest : if 
deep, they occasion a vibration of the thoracic walls, perceptible 
to the touch ; if high, not. Still we cannot, as has been men- 
tioned already under the head of vocal fremitus, from its exten- 
sion, draw any conclusion as to the extension of its cause, because 
this sound may be propagated, like the fremitus, from a single 
point where it originates to all parts of the chest. 

These rattling noises generally have their origin in catarrhal 
affections, and change constantly according to the location and 
the different nature of phlegm, which is shifted from one place to 
another by breathing and coughing. Exceptions to the above 
are hissing sounds, which sometimes exist continuously for weeks, 
and even months. These hissing sounds, or rhonchi sibilantes, 
must have, therefore, a more persistent cause, the nature of which 
seems to be a constriction in some of the finer bronchi: and we 
find them in such a persistent manner only in tuberculosis of the 
apices of the lungs. 

The so-called moist sounds are thought to originate in the pres- 
ence of a fluid, which, by the rush of air. is stirred up into large 
and small bubbles, which burst, AVe may distinguish the fol- 
lowina; varieties : 



AUSCULTATION. 357 

1. Rhonchus crepitans, vesicular crepitation, or crepitant rattle. 
It is quite similar to the noise which is produced when a lock of 
hair is rubbed between the fingers. It is heard only during in- 
spiration. Laennec and. all his followers, even Skoda, explain it 
in this way: that the rush of air during inspiration into the 
finest bronchial tubes and air-cells, if they contain a fluid, stirs 
this fluid into bubbles, which burst and thus cause the crepitant 
rattle. Already Walshe, an English author, Avas not satisfied with 
this explanation, and according to his opinion it originates 
through the sudden expansion of the interstitial spaces around 
the air-cells by a full inspiratory action. He thought these inter- 
stitial spaces glued together by the exudation of a tough matter 
in pneumonia, so that a sudden expansion would tear them 
asunder and cause this crepitation. This opinion of Walshe has 
already been refuted by Davies in his lectures, who says, that in 
pneumonia the exudation does not take place outside but inside 
of the air-cells, as the tough sputa sufficiently show, and that the 
same crepitating sound is also found in oedema of the lungs. 
Dr. Wintrich gives, no doubt, the best explanation of this sound. 
He says : " This crepitating sound is nothing else but the noise 
which is caused by the sudden inspiratory expansion of the air- 
cells and finest bronchial tubes when their walls have become 
glued together by means of a sticky exudation." It is therefore 
not heard in a sound lung, because here the air-cells, even dur- 
ing the fullest expiration, never contract to such an extent that 
their walls touch each other and stick together. Wherever it 
exists, there is a morbid swelling and tough secretion within 
these air-cells and finest bronchial tubes, which bring their walls 
during expiration in such near contact that, by means of a sticky 
secretion Avithin, they are glued together and torn asunder by the 
following inspiratory action. 

The intensity of this crepitation depends upon the toughness 
of the secretion and upon the force with which inspiration tears 
the adhering walls asunder. It does not cease after coughing 
and expectoration, because it depends upon a swelling and secre- 
tion of the air-cells and finest bronchial tubes, which no cough 
can remove. It is heard at the commencement of pneumonia, just 
when exudation takes place, and at its resolution; in capillary 
bronchitis, and in cedema and sometimes in emphysema of the lungs. 
In oedema the crepitant rattle is much softer and distant, because 
the transudation is of a much less sticky nature than in pneu- 
monia or bronchitis. 



358 THORAX. 

It is heard, lastly, in sound lung under the following condi- 
tion, as Walshe describes it: "If individuals whose lungs are 
healthy, or diseased only at the apices, and whose breathing is 
habitually calm, are made suddenly to respire deeply, a peculiar, 
fine, dry crepitation, accompanying inspiration only, may often be 
detected at the basis posteriorly. But after two or three, or, at 
most, five or six acts of respiration, it totally disappears. This 
pseudo-rhonchal sound seems to depend on the sudden and 
forced unfolding of air-cells, which are unaffected by the calm 
breathing habitual to the individual ; and its only import- 
ance arises from the possibility of confounding it with crepitant 
rhonchus." 

It is frequently heard in patients who have lain long on their 
backs, especially after typhoid fevers, and may be explained in 
the same manner. The pulmonary secretion collects mostly in 
those places which lie deepest and are used least. By these means 
the air-cells gradually collapse and stick together. A few deep 
inspirations tear them asunder and at the same time remove the 
secretion, so that, as there is no morbid swelling in these parts, 
the crepitant sound ceases after two, three, or, at most, after five 
or six acts of respiration. 

2. The subcrepitant rattle. This is a sound which appears to 
arise from the bursting of very small bubbles in the air-passages. 
It is heard most distinctly during the act of inspiration, weaker 
during expiration. It denotes a fluid secretion in the finer bron- 
chial tubes. 

3. The mucous rattle. There is sometimes a great deal of 
mucus in the respiratory organs; and yet, on auscultation, no 
rattling sound is perceptible. It seems, then, that certain condi- 
tions must exist in order to render the bursting of large and 
small bubbles in the air-passages audible. These conditions are : 
that the walls, wherein the sound originates, must be good reflec- 
tors of sound, like the larynx, the trachea, cavities, and bronchi, 
if they are surrounded by walls which do not contain air: and 
also, that fluid (mucus, pus, blood, serum) be contained in them, 
which, by respiration, is set into bubbling motion. This mucous 
rattle varies very much in character; is a sound of large or small 
bubbles, high or deep in pitch ; confined to a small spot, or ex- 
tended over the whole lung. By the extension of the sound we 
can never judge of the extent of the fluid which gives rise to it : 
because this sound is propagated quite a distance from its origin, 



AUSCULTATION. 



359 



if there exist good reflecting media. It therefore does not in- 
dicate any particular disease, but only certain conditions, like 
consolidation of the lung tissue, either by infiltration or hepatiza- 
tion, compression or atrophy. 

4. The metallic tinkling. "When, in consequence of a com- 
munication with a bronchial tube, or a portion of the lung, the 
pleural sac contains a considerable portion of air, and also a 
small quantity of fluid, or when a phthisical cavity of large size 
is similarly circumstanced, there is every now and then heard a 
very peculiar sort of tinkling noise upon examining the chest. 
It resembles very nearly the sound caused by shaking a pin in a 
decanter. This is the metallic tinkling. It is, most commonly, 
heard only at intervals; that is, it may occur once in three, four, 
or forty respirations. It rarely, if ever, attends the expiration. 
It may cease altogether, and reappear after a considerable time. 
In this respect it seems to be influenced by the position of the 
patient's body. It is most probably produced by the continued 
and rapid reverberation of a delicate sound against the firm and 
vibrating walls of a large cavity. It is in fact an echo in a small 
space. The original sound from which the echo proceeds ap- 
pears most commonly to arise from the bursting of a bubble of air, 
or from a drop of liquid falling upon the surface of fluid in the 
bottom of the cavity. But it sometimes seems to be likewise pro- 
duced by the passage of air over a loose portion of membrane or th ick 
secretion situated in a tube at or near the entrance of the cavity. 
The physical conditions necessary for its production appear to 
be a large cavity with resonating walls, and containing a large 
portion of air, with a small quantity of fluid." (H. M. Hughes.) 

In pneumothorax much depends upon the position of the pa- 
tient. Often, when nothing can be heard while the patient is 
lying down, the metallic tin/ding appears at once on assuming the 
sitting posture. In those cases in which tubercular infiltration 
extends to the diaphragm in the left lung, it not unfrequently 
happens that sounds within the lungs are conducted into the 
cavity of the stomach, where they cause exactly the same me- 
tallic tinkling. Any one, who is not aware of this fact, might 
easily diagnosticate pneumothorax where, upon post-mortem ex- 
amination, none could be found. 

Another practical and interesting sound is 

5. A sort of click, which is heard occasionally, perhaps not 
oftener than once in four or six inspirations, resembling the 



3G0 THORAX. 

sticky noise produced by the removal of the tongue from the 
roof of the mouth. It is generally observed at the apex of the 
lungs, when there is a deposition of tubercles, and, according to 
Wintrich, especially when these tubercles commence to dissolve. 
Cough sometimes breaks it up; but often it is of a very persistent 
nature. 

6. Friction sound. This sound originates when both pleural 
surfaces (pleura pulmonalis and costalis) become roughened and, 
in the absence of gas, fluids, or adhesions between them, rub 
upon each other. It generally accompanies both inspiration and 
expiration; being at one time most distinct during inspiration, 
at another during expiration. It may be heard during inspira- 
tion only, or the reverse. It resembles the creaking of leather ; 
appears at intervals, and in most cases it is recognizable by the 
finger as well as by the ear, and the patient generally experi- 
ences the sensation of something- rubbing within his thorax. 
This sound is most commonly caused by pleurisy and pericarditis. 
It is sometimes heard at the commencement of this disease, 
when fibrous deposits have settled on the surfaces of the pleura, 
and the contact of the surfaces is not prevented by serous effu- 
sions. It is also heard, and sometimes more distinctly, at a later 
period of the disease, when absorption of the serous effusion has 
taken place, and the surfaces, covered by a firm plastic exuda- 
tion, have once more come in contact, In this case the friction 
sound continues until either the pleura has formed adhesions to 
the thoracic walls, or its surfaces have become perfectly smooth. 
It is also heard in tuberculosis ; especially in the left infra-clavi- 
cular region, where it continues to be sometimes for months, 
even years; because tuberculosis is more or less always attended 
by partial pleuritic inflammations. Here, however, it must not 
be confounded with the above-mentioned interrupted or jerk-like 
expiration. Both may easily be distinguished, as already stated, 
by listening to the larynx. If heard there too, it is no friction 
sound, but interrupted expiration. 

Auscultation of Voice. 

The voice, as heard in a normal condition of the respiratory organs. 
If the stethoscope be placed upon the larynx of a healthy person, 
and we listen through it whilst the person is talking, his voice 
sounds nearlv as loud as though he were talking immediately 



AUSCULTATION. 361 

into our ear; but the words are not so clearly articulated. The 
same is true if we place the stethoscope upon the trachea. This 
normal sound, heard at the larynx and trachea during talking, 
has been called Laryngophony and Tracheophony — laryngeal voice 
and tracheal voice. 

If the stethoscope be placed upon the upper part of the ster- 
num, or upon the cartilages of the second and third ribs, or upon 
the inter-scapular regions, we may still hear his voice when he 
speaks, but much less loud, and the words will be still less clearly 
articulated than on the larynx and trachea. This normal sound 
of the voice, as we perceive it over the larger bronchial tubes, is 
called Bronchophony — hronchial voice. 

If, lastly, the stethoscope be put upon any other part of a 
healthy person's thorax, the voice of the person is heard simply 
as a buzzing or humming, or is not heard at all. 

Such then are laryngophony, tracheophony, bronchophony 
and the distant humming or buzzing of the voice, when heard 
over the respiratory organs in a normal condition. It must not, 
however, be supposed that there exists any defined line of demar- 
cation between each, so that it could be said, here ends laryngo- 
phony, and here begins bronchophony. They all gradually 
merge into each other ; they are not distinct species of sounds, 
but merely variations of intensity of the same sound. We may 
convince ourselves of this gradual lessening of intensity and clear- 
ness of articulation, if we gradually move the stethoscope from 
above downwards, and listen at the same time, whilst the person 
is talking. 

Further, it must be remarked and borne in mind, that the 
thoracic voice is very generally more distinct upon the right side, 
and particularly below the right clavicle and over the right 
scapula, than in the corresponding situations upon the left side ; 
also, that a shrill or acute, high-toned voice, generally sounds 
clearer and more distinctly modulated than a deep base voice, 
though not so loud and strong as this ; and that the thoracic 
voice is usually more audible in thin persons than in those whose 
thoracic walls are loaded with fat ; and in persons with contracted 
chests, than in those in whom the thoracic cavity is largely de- 
veloped ; and, other things being equal, it is also more distinct 
in females than in males. 

The voice as heard in abnormal conditions of the respiratory organs. 
Pathological changes and conditions multiply these variations 



362 THOKAX. 

in intensity and articulation of the voice still more. We will 
frequently have to make nice distinctions, and this is only pos- 
sible, if we compare constantly both sides and different parts 
with each other, for it rarely ever happens that both lungs should 
be alike affected. Thus, in listening to the sound portion we ob- 
tain a standard by which we are enabled to judge of the corre- 
sponding portion. There is a threefold alteration of the thoracic 
voice from its normal condition possible : it is either — 1. Decreased 
in its intensity or suspended altogether; or, 2, Its intensity and clear- 
ness of articulation is augmented; or, 3, It is changed altogether in 
its character. 

1. Its decrease is caused by any and all such solid, fluid or 
gaseous substances as may form between the lungs and thoracic 
walls, and which interfere with the transmission of the natural 
humming or buzzing of the voice on those parts of the thorax 
mentioned above. This is the case in moderate effusion of lymph 
or pus into the pleural sac, and in moderate pneumothorax, as 
far as it sepaiates the lungs from the thoracic walls. It is the 
case in widely-extended emphysema, if the bronchial tubes are 
not widened and thus made good conductors of sound. It is the 
case, where large cavities, as it were, swallow up the sound. It 
is quite important that all this be borne in mind, lest we might 
make mistakes. 

The natural thoracic voice is entirely subdued, when massive 
exudations and transudations in the pleural sac cause a separa- 
tion of the thoracic organs from the thoracic walls. The same is 
produced by pneumothorax, if it does not cause metallic tinkling. 
The most total suppression, however, of the thoracic voice is caused 
by the closure of the bronchial tubes, either by foreign bodies, 
tough mucus, large quantities of pus, phlegm, or serum, etc. The 
higher up towards the larger bronchi such stoppage exists, the 
larger is the circumference in which the natural thoracic voice 
is wanting. 

2. Its increase in intensity as well as in clearness of articulation. 
At first I have to remark, that in no case of morbid affection, 
and on no part of the thoracic cavity, does the voice sound so 
loud as at its origin, the mouth. But it may sound as loud, or 
nearly as loud, as we hear it in a normal condition at the larynx. 
This increase of the thoracic voice we may call Laryngophony 
French authors have called it Pectoriloquy, which means a speak- 
ing out of the chest. If it exists in a degree, as on those places, 



AUSCULTATION. 363 

where the larger bronchial tubes lie, near the thoracic walls, it 
is called Bronchophony. Neither pectoriloquy nor bronchophony 
arc always of the same strength or loudness, and therefore the 
authors speak of a perfect and an imperfect pectoriloquy, and of 
a loud and a weak bronchophony. 

The question arises, what causes this increase of the thoracic 
voice to bronchophony and pectoriloquy in places where there 
should naturally exist only a humming or buzzing of the voice? 

The answer is : This increase of the thoracic voice depends entirely 
upon a greater or lesser degree of aptness of the bronchial tubes to re- 
flect and conduct sounds, or, as we remarked of vocal fremitus, its 
increase depends upon good conductors of vibratory motion. This 
aptness of the bronchial tubes grows in the same degree as their 
walls become tenser and more solidified, approaching in consist- 
ency the walls of the trachea and larynx; and further, when 
these tubes are surrounded by fluids or semi-solid exudations (as 
in pneumonia) ; or even by solid masses (as in tuberculous infil- 
trations) ; or when the substance of the lungs around them has 
become compressed, and thus deprived of air. All these require- 
ments for an increase of the thoracic voice we find more or less 
realized in the following pathological conditions: In tubercular 
infiltration, if it surround several bronchial tubes up to their last 
extremities (this is of the most frequent occurrence); in pneumonic 
infiltration, where the semi-fluid or coagulable exudation causes 
hepatization of the substance of the lungs ; in strongly-developed 
oedema, especially of interstitial lung tissue, and this only in rare 
cases ; in dilatation of the bronchial tubes, if surrounded by indura- 
ted and shrinking, airless lung tissue ; in tumors of all kinds, if 
they compress the lung tissue, or by their own nature and situa- 
tion around the bronchial tubes become good conductors of 
sound ; in all kinds of fluid exudations into the pleural sac, pleu- 
ritic exudation, hydrothorax, hemothorax, empyema, etc., when 
they compress the lung to such a degree that the peripheric por- 
tions of it become deprived of air — : in such cases, however, the 
lung must not be pushed too far from the parietes of the thorax, 
as, for example, during the period of dilatation in pleuritis, in 
which, in the majority of cases, no sound is heard at the corre- 
sponding wall of the thorax; in cavities, which stand in unbroken 
connection with the larynx, trachea, and larger bronchial tubes, 
which have smooth walls that are good reflectors, which are nei- 
ther too large nor too small, and which are situated so near to 



364 THORAX. 

the periphery that but little previous lung tissue intervenes be- 
tween them and the thoracic walls — the nearer they are to the 
periphery and the tenser and harder their walls, the greater is 
the intensity of the thoracic voice heard over them. 

This increase of the thoracic voice in consequence of these 
pathological conditions over parts which, in a normal state, af- 
ford only a humming or buzzing of the voice, has been called, as 
already stated, according to its degree, weak or loud broncho- 
phony, and imperfect or perfect pectoriloquy. Bronchophony 
has always a kind of nasal twang, is never so clearly modulated as 
sounds or words wdiich come immediately from the mouth. 

3. The thoracic voice is changed in its character. Such a peculiar 
deviation from bronchophony is the so-called segophony, a tremu- 
lous sound, which resembles the bleating of a goat, and which is 
nothing but a modified bronchophony, with the nasal twang of 
quick, successive, tremulous interruptions. (Wintrich.) It is 
heard sometimes without any pathological change, in old people, 
if their voice has become of a trembling character. Otherwise it 
is found under conditions similar to those which produce broncho- 
phony, and does not designate any particular condition or dis- 
ease. It corresponds to the cracked-pot sound. 

Another deviation from bronchophony is the cavernous voice, 
which is well modulated, without nasal twang or goat-bleeting. 
It originates in moderately large cavities, which are situated near 
the thoracic w T all and adhere to it ; which have thin, smooth 
walls, capable of good reflection ; which are, by the larger bron- 
chial tubes, in uninterrupted connection with the larynx and 
trachea, and which do not contain too much fluid. 

If these cavities are large, another deviation from mere broncho- 
phony is occasioned, which is spoken of in books under the name 
of emphoric echo and metallic tinkling. These phenomena may be 
imitated by a person speaking and directing his voice into a jug. 
When he does so, a peculiar humming is heard in addition to 
the voice. Besides this humming, there is also occasionally 
heard a metallic after-tone, both of which represent what Laennec 
describes under emphoric echo and metallic tinkling. It is pro- 
duced in tolerably large cavities, and also sometimes in pneumo- 
thorax. 

Auscultation of Cough. 

As cough is nothing else than a loud and forced expiration, it 
is clear that all which has been said about respiration and voice 



BRONCHITIS, BRONCHIAL CATARRH. 3G5 

is likewise applicable to the cough. It is heard weaker or louder 
under the same conditions which decrease or increase the sound 
of respiration and of voice. In some cases it may make some of 
the auscultatory signs clearer and more distinct, and thus far it 
may be a help to a more accurate diagnosis. 

Special Diseases of the Respiratory Organs. 

Having thus far explained, step by step, the phenomena which 
respiratory action, in normal as well as abnormal conditions, of- 
fers to the senses of sight (inspection), touch (palpation), and hear- 
ing (percussion and auscultation), we now come to consider cer- 
tain forms of abnormal conditions of the respiratory organs which 
occur again and again ; and although varying constantly as in- 
dividual cases, present, nevertheless, some common, persistent 
features by which they may be arranged, considered, and recog- 
nized as definite and marked forms of pathological alterations 
and conditions in these organs. What we have learned concern- 
ing the respiratory action in normal and abnormal conditions, 
we shall now have occasion to apply to certain diseases, and in 
this way demonstrate its practical use. 



a. AFFECTIONS OF THE BRONCHIAL TUBES. 

Bronchitis, Bronchial Catarrh. 

This, like all catarrhal inflammations, is characterized by a 
hyperaemic state of the mucous membrane in the bronchial tubes, 
causing abnormal secretions, and if long continued, gradual 
changes in their texture. The membrane appears injected, 
ecchymosed, infiltrated, opaque, swollen, and covered with secre- 
tion. In this way the finest tubes may become entirely closed, 
preventing the renewal of air in the air-cells, and causing a 
poisoning of the blood by uneliminated carbon. This generally, 
however, happens only with infants, who are not strong enough 
to free themselves of the secreted phlegm. In such cases, during 
post-mortem examination, the lungs swell out of the thorax, not 
having room enough inside without being compressed by the 
parietes of the thorax, because their alveoli remain filled with 
the inhaled air. In chronic cases the mucous membrane grows 
hypertrophic, the muscular fibres lose their elasticity, and the 



366 AFFECTIONS OF THE BRONCHIAL TUBES. 

tubes enlarge in width, either evenly throughout, or only in short 
tracts, sac-like, — Bronchiectasia. 

The inflammation may be confined to the trachoa and the 
larger bronchi, or to the smaller ones, or be diffused all over. In 
the first case it is accompanied more or less by a troublesome 
tickling under the sternum, or a sore feeling or burning ; while 
in the second no such sensations exist, as the finer bronchi are 
less liberally supplied with sensible nerves than the larynx and 
trachea. The cough is usually much more violent in the case of 
inflammation of the larger bronchi; it is most readily excited at 
the point of biforcation. If the catarrhal inflammation is located 
in the smaller bronchi, it is always attended with more or less 
dyspnoea, which, in an affection of the larger bronchi alone, is 
never found, and for obvious reasons : the swelling and phlegm, 
if ever so great, can not easily occlude these large tubes, while in 
the smallest a little swelling and a small quantity of phlegm may 
easily prevent the undisturbed ingress and egress of air. 

The sputum is at first viscid, mucous, transparent, poor in cells, 
often frothy, because mixed with air from the severe efforts of 
coughing required for its detachment; often it is mixed with 
small quantities of blood for the same reason ; in the spit-cup it 
is readily confluent and corresponds to the sputum crudum of older 
writers. As the catarrh progresses, more and more cellular ele- 
ments become freed, and this is a sign that the culmination of 
the process is passed ; the sputum now is richly cellular, non- 
translucent, and consists chiefly of mucus and pus cells — it is the 
"sputum coctum" of older writers. If the disease enters the chronic 
stage, the sputa become more puriform, and appear either in 
greenish or yellowish clumps of muco-pus in a sero-rnucous fluid, 
of which, when poured into water, one portion remains floating on 
account of the admixture of air, while the rest sinks to the 
bottom ; or the purulent masses run together in the spit-cup of 
which the heavy portion settles to bottom, the sero-mucous part 
floats upon it and the whole is covered by considerable froth ; 
this sort of expectoration is often fetid in a high degree ; or the 
sputa consist of roundish, coin-like masses, which lie separate be- 
side each other in the spit-cup ; this sort of expectoration is often 
the product of a cavity in the lungs, but is also observed in 
chronic bronchitis. At still other times the sputum is sero- 
mucous, being characterized by its thin, thready consistence, fre- 
quently copiously mixed with air-bubbles which cover the entire 



BRONCHITIS, BRONCHIAL CATARRH. 3G7 

surface of the expectorated mass. Its quantity is often very 
considerable, amounting to actual bronchorrhoea, and is prin- 
cipally observed in the chronic forms of bronchitis. The ashes 
of these various kinds of sputa have been found to contain : 
Chlorine, sulphuric acid, phosphoric acid, potassa, soda, lime and 
magnesia, oxide of iron and silicic acid. The same constituents 
are found in the ashes of the lungs, but their quantitative com- 
position differs greatly. Phosphoric acid, for instance, and oxide 
of iron are found of much less amount in the sputa than in the 
ashes of the lungs, whereas potassa exceeds greatly in amount in 
the ashes of the sputa. 

Bronchitis, whether confined to the larger or smaller tubes, is 
most always attended with fever. It generally sets in with chilli- 
ness, alternating with a feeling of burning heat, without a corre- 
sponding rising of the mercury when the thermometer is applied. 
Thus we may already in the commencement of a fever be able 
to distinguish a catarrhal from an inflammatory fever; the latter, 
generally commencing with only one chill, is followed by a fever- 
heat that indicates a much higher degree on the thermometer. 

Catarrhal fevers are sometimes epidemic, when they are called 
Influenza or Grippe ; involving the whole system and especially the 
mucous membranes, even those of the bowels. 

In old people, or otherwise exhausted persons, catarrhal fevers 
take at times a bad turn, and assume a typhoid character. The 
patient becomes delirious and comatose, his tongue dry, pulse 
small and frequent, and his person covered with exhausting per- 
spiration. To the comatose state is added at last, a rattling in 
the trachea from the bursting of big bubbles, which is caused by 
the inability to throw off the phlegm, in consequence of paralysis 
of the muscular fibres of the bronchi. This is the so-called death- 
rattle; after the setting in of which the scene soon closes. This 
form of bronchitis is termed by older writers Pneumonia notha. 

Another form is the so-called Catarrh on the chest of infants, es- 
pecially during dentition. It involves the smallest branches of 
the bronchi, whence it is also called Bronchitis capillaris. Its char- 
acter is the same with any other form of catarrh; but as the 
swelling attacks the finest tubes, it soon makes them impervious 
to air, and consequently prevents the expulsion of carbon, and 
the inhalation of oxj'gen. Such children are in great distress, 
breathing heavily, with hissing and rattling noises in the chest. 
The coughing spells are painful and violent, driving the blood to 



500 AFFECTIONS OF THE BRONCHIAL TUBES. 

the face, and when still further progressing, the epigastric region 
and lower ribs are drawn in during inhalation, as in croup, a 
sign that the air-cells are no longer filled by the inspiratory act ; 
so also do we find the supra and infra-clavicular region bulging 
out, protruding, as the air contained therein is not removed by 
expiration, and there is consequently a noticeable stillness of the 
upper part of the chest during expiration. 

When such an attack befalls newborn children from their 
having been exposed to cold by washing, bathing, etc., it sooner 
develops itself into a higher stage, as the child is too young and 
too weak to clear away the accumulating secretion by its own 
efforts. The child turns bluish and grayish; the nose becomes 
pointed; the eyes dull; and the respiration quite superficial. It 
is nothing more nor less than a clogging up of the finest bron- 
chial tubes, and, in consequence of that, an overcharge of the 
whole system with carbon. A superficial observer might con- 
found it with cyanosis from some organic lesion of the heart. 

The chronic forms of bronchitis differ but little from the acute 
forms. A chronic bronchial catarrh aggravates usually in spring 
and fall, and leaves the patient comparatively free through the 
summer. In some cases where the sputa are very tough, it is at- 
tended with painful, straining fits of coughing, in others the 
cough is much lighter, as the secretion consists of a more fluid 
and yellowish substance. Very frequently bronchial catarrh is 
attended with dyspnoea on account of constrictions which, by the 
chronic inflammation, have been formed within the air-tubes. 
So also originate by the gradual change of texture of the bronchi, 
dilatations here and there (Bronchiectasias), which in most cases 
contain masses of puriform sputa of a very fetid odor. In other 
cases, especially where the catarrhal inflammation is located in 
the larger bronchi, the expectoration is of great abundance, and 
consists of a thin, sero-mucous substance, mixed largely with air- 
bubbles. Such abundant discharge from the air-tubes is called 
Blenorrhcea.of the Bronchi, or Bronehorrhoea. In some cases there is 
no great dyspnoea, in others where the inflammation infests the 
finer tubes, dyspnoea will not be wanting. 

A long continuance of chronic catarrh often becomes associated 
with hypertrophy and dilatation of the right ventricle of the 
heart. A particular form, the so-called "Dry Catarrh" of Laennec, 
which is associated by severe paroxysms of cough with but a 
trifling amount of expectoration, is often combined with em- 
physema. 



BRONCHITIS, BRONCHIAL CATARRH. 369 

Physical Signs. — Percussion reveals nothing in these affections ; 
its sound is everywhere the same as in a healthy condition. 

Auscultatory signs depend upon the condition of the bronchial 
tubes. As soon as their mucous lining becomes inflamed and swollen, 
the vesicular murmur is loud, harsh, and coarse ; the expiratory 
murmur, usually scarcely audible, also partakes of this character, 
and may be even louder than the inspiratory murmur. When, 
however, the inflammation invests the larger bronchial tubes, 
the vesicular murmur is frequently oversounded by the loud 
bronchial breathing which originates there; but, when the 
breathing is slow and weak, there may be, at the commencement 
of the disease, no sound at all perceptible. 

As soon as the mucous membrane becomes covered with secretion, 
we hear all sorts of mucous rattling, fine bubbling, large bub- 
bling, hissing, and whistling sounds, according to the nature and 
location of the secretion. When the secretion is located in the 
larynx, trachea, or larger bronchi, the rattling noise originating 
here may be heard all over the chest; hence we cannot, from the 
extent of the noise, judge of the extent of the secretion. On the 
contrary, the finer bronchi may be filled with mucus, and no 
rattling noise be perceptible when the breathing is weak and 
feeble. When, during vigorous respiration, the vesicular mur- 
mur is absent, it denotes the presence of a large quantity of mu- 
cus, or the closure of the finest bronchial tubes by swelling, 
which prevents the air from entering into the air-cells. We may 
also hear the crepitant sound, when the inflammation invades the 
finest bronchi. 

In regard to differential diagnosis, bronchial catarrh differs from 
other acute lung diseases by the absence of acute pain — it pro- 
duces only a sore, raw, and burning sensation ; by the absence 
of all abnormal percussion signs ; and by its commencing with 
frequently repeated chills. 

THERAPEUTIC HINTS.— Catarrh on the chest of infants, Aeon., 
Bellad., Bryon., Calc. carb., Ferr. phosph., Ipec, Laches., Opium, 
Phosphor., Sulphur, Tart. emet. 

Catarrh of old people, or exhausted persons, Baryt. carb., Bryon., 
Carb. veg., Hydrast., Laches., Phosphor., Bhus tox., Sepia, Tart, 
emet., Veratr. 

Compare Catarrh of Nose and Larynx. 

Acute Forms. — Aeon., in the commencement, especially if brought 
24 



370 AFFECTIONS OF THE BRONCHIAL TUBES. 

about by exposure to cold west winds, or sudden suppression 
of perspiration, with high fever, dry skin, restlessness and irasci- 
bility. 

Act. rac, cough excited by every attempt to speak, so that one 
is obliged to desist. (Guernsey.) 

iEsc. hipp., when complicated with gouty diathesis, and a tend- 
ency to piles with constipation. 

Arnica, cough excited in children from crying ; sputa difficult 
to loosen, or bloody. 

Arsen., cough attended with dyspnoea; worse about and after 
midnight; from drinking cold water; from lying down; from 
mental excitement; sometimes attended with cold in head, diar- 
rhoea, rheumatic pains in the limbs, palpitation of the heart, rest- 
less anxiety in the night. When coughing a pain extends from 
the small of back down into the thighs. The cough is excited 
by an intense tickling in trachea and under sternum, from cold 
air; it is whizzing with difficult expectoration of frothy, tough 
sputa. 

Badiaga, spasmodic cough, with sneezing and lachrymation ; 
during the paroxysms, crying and pressing hands upon head; 
sometimes strangling, face turning dark, and thick, yellow viscid 
mucus flying out of mouth and nostrils. Cough loose a.m., tight 
p.m. (H.V.Miller.) 

Bellad., barking cough; crying when coughing; hot skin, in- 
clined to be moist; drowsy; sleepy, but cannot sleep; starting in 
sleep. 

Bryon., crying when being moved, and when coughing; cough 
tight, sometimes with blood-streaked expectoration; worse 
through day, at times worse in the night, compelling to sit up; 
worse from motion; when entering a warm room; from sudden 
changes of the atmosphere, either to warm or to cold ; from eat- 
ing and smoking. Pain in the pit of stomach, and in the mus- 
cles under the short ribs, or in the sides of the chest, or in the 
head when coughing; spirting of urine when coughing. The 
cough is at times excited by a tickling in the pit of the stomach. 

Calc. carb., teething children; loose cough; rattling of mucus; 
bowels moved more frequent towards evening; profuse head 
sweat, especially during sleep. 

Carb. veg., evening hoarseness; burning under sternum; sore- 
ness of chest, and heat of body when coughing; itching from 
throat down to centre of chest when coughing. The cough 



BRONCHITIS, BRONCHIAL CATARRH. 371 

comes mostly in spells far apart; is excited by going into the 
cold air out of a warm room. Cold knees in the warm bed. Py- 
rosis with great flow of water from the mouth during the day. 

Caustic, morning hoarseness ; cough worse on getting warm in 
bed; also better in bed and from a swallow of cold water; is at- 
tended with pain over the left hip; involuntary discharge of 
urine. Heartburn and acidity after fat, saccharine and farinaceous 
food; sudden cramps in heel-cords in the night; stiffness and 
lameness of jaws. 

Chamom., during teething; cough during sleep without wak- 
ing; child wants to be carried and is very cross. Suffocative 
constriction of the chest as if the throat were throttled, with con- 
stant desire to cough. 

Cilia, dry hacking cough, especially at night, followed by swal- 
lowing, as if something were rising in the throat; the child be- 
comes stiff during the cough, and afterwards there is a clucking 
noise in the throat down to the stomach. 

Cinchona, tickling cough worse from talking or laughing. 

Conium, cough worse from horizontal position, speaking or 
laughing. 

Cuprum, cough better from taking a sip of cold water; trembling 
after coughing; suffocating spells. 

Drosera, the cough seems to come from the abdomen and con- 
vulses the muscles of the chest and abdomen ; the patient tries 
to relieve the pain in chest and hypochondriacal regions by hold- 
ing them tightly; perspires immediately on waking from sleep. 

Eupat. perf., rough, scraping cough; violent cough with soreness 
in the chest; the patient supports the chest with his hands; 
cough before and after meals; pain in all the limbs and back; 
palpitation of the heart. 

Euphras., dry, tickling cough only in daytime, better from eat- 
ing, and drinking small quantities of beer or water. After the 
cessation of hsemorrhoidal flow. 

Ferr. phosph., often relieves the catarrh on the chest of children, 
similar to Aeon. 

Hepar, cough tight or loose, worse in the morning ; from un- 
covering any part of the body; better from wrapping up and 
keeping warm. Repelled eruptions. 

Hyosc, nightly, dry, spasmodic, titillating cough, worse in 
lying. 

Ipec, titillating cough with dyspnoea, nausea and vomiting, 
diarrhoea ; face pale, even bluish during cough. 



372 AFFECTIONS OF THE BRONCHIAL TUBES. 

Iodium, tickling, dry cough ; young persons subject to spitting 
blood ; palpitation of the heart ; swelling of cervical and bron- 
chial glands ; progressive emaciation by good appetite. 

Kreosot, during dentition, when the child is extremely fretful, 
irritable, much agitated, and screaming in the night. Dry cough 
excited by a crawling sensation below the larynx. 

Laches., cough is worse during and after sleep; in afternoon 
and evening; there is tickling in the pit of the throat and great 
sensitiveness of the throat to any touch ; during cough, stitch 
pains in the hsemorrhoidal tumors ; the stools are fetid even if 
formed. 

Mangan., spasmodic cough from afternoon till bedtime, ceasing 
on lying down, worse from motion ; expectoration scanty and 
difficult, causing long efforts of coughing for its expulsion; in the 
morning easy. Sore and bruised feeling through the chest. 

Merc, sol., catarrh of the whole mucous membrane from the 
nose down ; chilliness and heat alternately ; feels hot in bed and 
chilly when moving his feet to a cooler place ; sweats without 
relief; cannot bear either warm or cold air; cough worse when 
lying on the right side ; tongue coated thick, yellowish ; great 
thirst for ice-water, although it aggravates the cough. 

Nux mosch., cough worse on getting warm in bed; excited by a 
creeping sensation from the chest to the throal; especially during 
pregnane)-. 

Nux vom., always after previous use of cough mixtures; cough 
worse in the morning; excited by beer, relieved by warm drinks. 
Nose stopped up in the evening; headache; fever with chilliness 
from slightest motion; irritableness ; oversensitiveness to light, 
noise and smells. Involuntary micturition when coughing, 
laughing or sneezing. 

Opium, convulsive, drj r , tickling cough in paroxysms, worse at 
night, with bluish redness and sweat in the face, and yawning 
after the cough. Drowsiness, and inability to go to sleep. 

Phosphor., tight cough, worse from evening till midnight: tight- 
ness across the chest; pain in the head, larynx and chest when 
coughing. Cough worse from speaking, laughing, eating, motion 
and on going into the cold air. Useful after onion syrup. 

Pulsat, chilliness; thirstlessness; loose cough with yellow or 
greenish expectoration ; tight in the evening on retiring to bed, 
often causing vomiting. After measles. 

Rhus tox., cough excited by a tickling under the middle of the 



BRONCHITIS, BRONCHIAL CATARRH. Sid 

sternum, worse from uncovering any part of the body; from 
laughing, talking, singing, and cold drinks ; better from warm 
drinks. Pain in the limbs during rest, which feel stiff and lame 
on first moving, but get better during exercise; restlessness. 

Rumex, dry cough in long paroxysms, brought on by any 
irregularity in breathing, taking a deeper breath than usual, 
talking; or from external pressure upon the throat-pit; worse in 
the evening after retiring; the patient covers his head all over, 
because the slightest draught of cold air at once brings on a dis- 
tressing tickling in the throat-pit and behind the sternum, more 
towards left side ; in walking he covers mouth and nose. (Dun- 
ham.) 

Senega, tough mucus causes the greatest, often ineffectual efforts 
of coughing and hawking for its expulsion. 

Sepia, cough seems to come from stomach or abdomen; nausea 
during and after cough. Tickling cough before midnight in bed, 
coming in rapid concussions until breath in exhausted, followed 
by expectoration of mucus with temporary relief. Worse in cold, 
wet weather. Eruption of hard papulae on a red base with 
burning and itching; herpetic eruptions and passive congestion 
of the womb. 

Spongia, cough wheezing and asthmatic, relieved by eating or 
drinking; oppression and breathing worse from lying with the 
head low. 

Sticta, dry, racking cough, with splitting frontal headache, 
from tickling in right side of trachea, below larynx ; cough ex- 
cited by inspiration. 

Sulphur, cough worse in evening on lying down, with itching 
in the bronchi, accompanied with retching. Hot flushes; cold 
feet ; or hot palms and soles, hot vertex. Rheumatic pains in 
knees and hips at night, with coldness and soreness; itching of 
skin on retiring. 

Tart, emet, rattling mucus; cough is followed by yawning; 
cough worse when lying; child wants to be carried about; worse 
after eating, with vomiting. Drowsiness; sticky perspiration; 
dyspnoea; cyanosis. 

Ver. alb., capillary bronchitis, with livid face, blue nails, cold 
extremities and tumultuous, irregular contractions of the heart ; 
cold perspiration on forehead when coughing; eyes half open 
during sleep. 

Zincum, child grasps the genitals when coughing. 



374 AFFECTIONS OF THE BRONCHIAL TUBES. 

The Chronic forms may require any of the remedies ahove de- 
tailed ; they may require one or the other of the following : 

Alum., cough worse about 6 o'clock in the morning, on and 
after getting up ; raises but little after considerable coughing ; 
sometimes the cough is troublesome all night; it often recurs 
with the cold season and lasts until the w T arm season sets in 
again ; the cough is relieved by lying flat on the face. Irritable 
persons and women who easily laugh or cry. Follows well after 
Bryon. 

Ambra gris., cough dry in the evening, gray sputa in the morn- 
ing ; excited by exertion and music. Aged people. 

Amm. carb., cough dry, tickling, with a sensation of heat and 
burning in windpipe under sternum, as of having swallowed 
alcohol; rough voice; from taking cold in rough, rather dry air. 
Aged people ; adynamic state. 

Amm. mur., cough with profuse,- thick, whitish expectoration, 
sometimes in lumps, with heaving ; mucous rattling in the chest, 
worse when lying, either without or with difficult expectoration ; 
burning in the chest; dyspnoea on moving and when lying; raw- 
ness and soreness in fauces ; coldness between the shoulders. Old 
age ; bronchiectasias ; emphysema. 

Arg. nitr., rattling cough; hoarse voice; marasmus, the legs 
are especially emaciated ; child cries much, unless carried about ; 
craving for sugar. 

Arsen., dry, spasmodic cough, with dyspnoea, asthma, suffocat- 
ing spells, cardiac troubles ; exhaustion, nervous irritability, hy- 
dremia. Worse at night ; from lying down, drinking and change 
of weather. 

Cale. carb., expectoration yellow, lumpy, sweetish, sometimes 
fetid ; when thrown into water, a lump is seen shooting to the 
bottom, with a mucous trail behind, like a falling star. (Fellger). 
For scrofulous individuals and such who have to talk a great 
deal, who are subject to hoarseness, to perspiration from any ex- 
ertion, and palpitation of the heart after eating. 

Carb. an., cough with hoarseness and night-sweats, very fetid 
and debilitating, following chill and fever in the evening ; cold- 
ness and aching in lumbar region and lower extremities. 

Carb. veg., burning in chest, heat and perspiration ; great weak- 
ness; oppression; want to be fanned. Coldness of skin; pointed 
nose ; rattling of large bubbles ; cold knees in bed. Exhausted 
and aged persons. 



BRONCHITIS, BRONCHIAL CATARRH. d75 

Cinchon., black, difficult expectoration; cough worse with head 
lying low, or when lying on left side, or when moving, talking, 
etc. ; better with head lying high. 

Corall. rubr., cold expectoration. 

Hepar, dirty yellowish expectoration, badly smelling; cough 
worse in the morning and when uncovering any part of the 
body ; bronchiectasia. 

Iodium, compare Acute Forms. 

Kali bichr., ropy expectoration ; cough excited from eating or 
drinking. 

Kali carb., dry cough, as. if excited by a dry membrane in the 
trachea, which cannot be detached ; slimy, salty expectoration ; 
cough worse about 3 o'clock, a.m., also from eating and drinking, 
with pain in lower part of the chest. Dry skin ; dry stool ; eye- 
lids red and swollen, especially between the brows and upper 
lids. After measles. 

Laches., compare Acute Forms. 

Lauroc, short, titillating cough from cardiac affections. 

Lobel. infl., "spasmodic contraction of the diaphragm in emphy- 
sema, accompanied by pain in epigastrium, tympanitis of the 
abdomen, impossibility of deep inspirations, extreme dyspnoea 
and cyanosis." (Meyhoffer.) 

Lycop., "chronic pneumonia; bronchitis, with copious muco- 
serous, or muco-purulent secretion ; emphysema ; dilatation of 
the air-tubes ; senile catarrh. Congestion of the liver, flatulency, 
constipation, cachectic complexion, red gravel, acid dyspepsia." 
(Meyhoffer.) "Cough dry day and night in feeble emaciated 
boys." (C. Wesselhoeft.) The cough ends with a loud belch ; 
salty expectoration. 

Natr. carb., cough is excited by coming into a warm room 
(Bryon.). 

Natr. nrar., transparent, viscid sputa; weak voice; fluttering of 
the heart ; worse on the sea-shore ; cutting pain in the urethra 
after urination. 

Natr. sulph., when coughing at night has to sit up and hold his 
chest with both hands ; asthmatic spells worse towards morning. 
Aggravation always from cold, damp and rainy weather. 

Nitr. ac, cough with thirst in the morning. 

Phosphor., besides a dry cough, there is in chronic cases often a 
free expectoration of abundant, tough mucus, especially in the 
morning. At times the expectoration is cool. Tremor when 
coughing. 



376 AFFECTIONS OF THE BRONCHIAL TUBES. 

Phosph. ac, cough in overgrown youths. 

Platina, chronic cough dependent on uterine diseases with men- 
tal disturbances. 

Plumbum, copious muco-purulent, or purulent expectoration. 

Sanguin., cough worse at night ; circumscribed redness of the 
cheeks ; burning dryness of the mouth and throat, not relieved 
by drinking. 

Secale, concussive cough ; profuse perspiration ; sleepless nights ; 
colic, diarrhoea and bloatedness of the abdomen. Emphysema. 

Sepia, compare Acute Forms. 

Silic, expectoration of pus, which when thrown into water, falls 
to the bottom and spreads like a heavy sediment. (Fellger.) 
Cough worse from cold, and better from warm drinks. 

Spongia, compare Acute Forms. 

Stannum, bronchial dilatations with purulent expectoration ; 
excessive muco-purulent expectoration; weak feeling in the 
chest. 

Staphis., cough is excited by eating meat, or cleaning the teeth. 
Very sensitive, feeling easily hurt when being reproached. Cer- 
vical and axillary glands swollen. 

Sulphur, often indicated in rheumatic, gouty, herpetic and scrof- 
ulous individuals, also when seemingly well indicated remedies 
refuse to act. Sensation as of ice in the chest whenever chilled, 
or perspiration is checked. Compare Acute Forms. 

Tart, emet, compare Acute. Forms. 

Tussis Convulsiva, Pertussis, Whooping-Cough. 

This affection is, in its nature, a species of bronchitis of an in- 
fectious and mostly epidemic nature, and not a mere nervous 
complaint. For although in some cases the nervus vagus has 
been found softened, and the medulla oblongata and its membranes 
hypersemic, these changes are not of a uniform occurrence and 
must be considered as mere accidental complications ; of constant 
presence on post-mortem examinations are the symptoms of ca- 
tarrhal inflammation; hypersemia, swelling and secretion of the 
mucous membrane of the larynx, trachea and bronchial tubes. 
In the beginning, whooping-cough cannot be distinguished from 
an ordinary bronchial catarrh; later, however, the fits of coughing 
assume that characteristic whoop, which consists in a long, 
crowing inspiration on account of a spasmodic closure of the 



TUSSIS CONVULSIVA. 377 

glottis, and which is followed by several short expirations in 
quick succession, ending most frequently with vomiting of ingesta 
and large masses of tough, gelatinous phlegm from the bronchi. 
Such paroxysms come as often as the collection of phlegm is 
sufficiently abundant to excite them. The child feels their coming 
and dreads them ; therefore it almost always strives to get hold of 
something whereby to support itself. During the paroxysm 
regular respiration and the action of the heart are very much 
interfered with, and it explains those cyanotic symptoms, which 
we so frequently observe in the face and on the neck, (bluishness 
and swelling of veins) and also the general convulsions, in con- 
sequence of congestion to the brain. Hard paroxysms, by their 
violent convulsive straining, not unfrequently cause bleeding from 
mouth, nose and even ears. In rare cases children are seen to 
succumb suddenly and unexpectedly during a coughing fit, either 
from severe and persistent spasm of the glottis, causing suffocation, 
or from effusion of blood, or transudation of serum into the brain 
and its ventricles, or from paralysis of the heart, or a rapid devel- 
opment of a diffuse pneumothorax. 

Whooping-cough has been divided into three stages: the ca- 
tarrhal, convulsive, and the critical. The first is like any other 
catarrh; the second is sui generis, characterized by its peculiar 
paroxysms, and in a majority of cases attended by an ulcer on 
one or both sides of the frsenulum lingua?, less often on the upper 
surface of the tongue, said to be the consequence of wounds re- 
ceived by thrusting the tongue between the teeth during the par- 
oxysms at a spot where they are either much inclined or very 
prominent; the third, like the first, is similar to an ordinary 
catarrhal affection, and gradually wears off. The popular belief 
in regard to whooping-cough is, "that it is six weeks coming, six 
weeks standing, and six weeks going;" but, like all popular ob- 
servations, this ought to be taken with some discrimination. For, 
although obstinate cases last a long while, under careful Homoeo- 
pathic treatment they never last that length of time. Its Physical 
Signs are precisely those of bronchitis. Whooping-cough may, 
when the inflammatory process spreads into the finest bronchial 
tubes and further combine with bronchitis capillaris, may cause 
pneumonia and emphysema; or, by its disturbance of circulation, 
bring about hypersemia and even oedema of the brain and its 
membranes. It is also not unfrequently complicated with measles, 
scarlatina and small-pox. In these complications lies its danger. 



378 AFFECTIONS OF THE BRONCHIAL TUBES. 

Ordinary, simple cases pass over without any difficulty, even 
without fever. 

Whooping-cough prevails mostly epidemically among children 
up to the 8th year of age, and, as a rule, attacks them only once 
in their life, and is said to be broken off at once by vaccination. 
It is of rare occurrence in advanced years, although it does 
occasionally occur. 

THERAPEUTIC HINTS.— For first stage, compare Bronchitis. 

Ambra gris., severe paroxysms of hollow-sounding cough ; op- 
pression and rapid respiration; expectoration of large quantities 
of tough, grayish or yellow mucus, especially after waking in the 
morning. (M. Preston.) The paroxysm ends with belching. 

Anac, fits of vexation excite the paroxysms; dyspnoea during 
and after the coughing spells; for children who are ill-natured 
and of an uncontrollable temper. (M. Preston.) 

Arnica, the child cries before the paroxysms; eyes are blood- 
shot; there is bleeding at the nose. 

Bellad., congestion to the head with red face and eyes ; crying 
when coughing; sneezing after coughing. 

Bryon., worse after eating and drinking with vomiting ; invol- 
untary loose stools during the coughing fits, involuntary discharge 
of urine. 

Calc. carb., teething infants; convulsions. 

Capsic, pain in the ears when coughing; ears and tip of nose 
hot; bloody mucus from nose when coughing; eyes protrude with 
burning and lachrymation. 

Carb. veg., vomiting of food; bleeding at the nose; cough worse 
in the evening and in the open air. 

Cilia, spasms of the extensor muscles; the child becomes sud- 
denly stiff; clucking noise, as though water were poured out of a 
bottle, from the throat down to the abdomen ; frequent sneezing 
after the paroxysm; bleeding from nose and mouth. For children 
who are inclined to frequently wet the bed, and pick at the nose, 
and who are obstinate and irascible. Fretting excites the cough. 

Cocc. cact, expectoration of ropy mucus, causing gagging and 
vomiting of food. Feel better in the open air. 

Cor. rubr., spasms of cough so violent that children lose their 
breath and grow purple and black in the face. 

Cuprum, convulsive, long-continuing paroxysms of coughing, 
worse from eating solid food, better from drinking cold water; 



TUSSIS CONVULSIVA. 379 

during the paroxysms loss of breath and convulsive throwing up 
of tough, gelatinous mucus, and afterwards constant rattling 
on the chest; bluish face and lips; convulsions of the flexor 
muscles. 

Drosera, worse after midnight ; feeling of constriction in chest 
and hypochondria, so that the patient tries to support these parts 
by the hands; worse from tobacco-smoke, and drinking; vomiting 
of ingesta and then of mucus. 

Hepar, for third stage. 

Hyosc, cough dry and worse at night in a recumbent position. 

Ipec, spasm of the glottis before the paroxysm; bleeding from 
nose and mouth during the coughing fits ; vomiting of mucus or 
food; convulsions and stiffening of the body backwards; vomiting 
of food without coughing ; rattling of mucus in the bronchial 
tubes; rash-eruption. 

Iodium, "patients are weak, sallow, short of breath, emaciated 
and have enormous appetite." (M. Preston.) 

Kali carb., paroxysms worse after midnight, about 3 o'clock a.m. ; 
bloated face, especially between upper eyelids and brows; dry skin, 
dry hair, and dry stools. 

Laches., coughing spells always worse after sleep. 

Ledum, dizziness and staggering after the paroxysm ; moaning 
and groaning during sleep ; spasmodic contractions of the dia- 
phragm after the spell, so that inspiration becomes double, sob- 
bing-like, as we observe after hard crying spells. 

Mephit, spells day and night; the child must be raised, gets 
blue in the face and can't exhale. Convulsions; fetid diarrhoea. 

Niccol., the cough is a dry hack, like the tick of a clock in its 
regularity, continuing for a long time. The child must be held 
straight up during the continuance of the cough, otherwise it 
is seized with spasms. The greatest possible degree of dyspnoea, 
but no expectoration. (M. Preston.) 

Naphthal., recommended by Yon Grauvogl. 

Nux vom., cough worse in the morning and after eating ; at- 
tended by vomiting, gagging, constipation, choking spells with 
bluish face, and pain in the abdomen. After previous quackery 
with cough-mixtures, drops, etc. 

Phosphor., third stage. 

Pulsat, first and third stage ; disordered stomach. 

Sepia, cough in rapid successions till breath is exhausted, then 
gagging and vomiting of mucus ; cough worse in the night. (C. 
Wesselhoeft.) 



380 AFFECTIONS OF THE BRONCHIAL TUBES. 

Squilla, cough excited by drinking cold water; involuntary- 
discharge of urine during the spell. 

Stramon., barking, croup-like cough with suffocative contrac- 
tion of the chest, rattling, palpitation of the heart ; anxiety, con- 
gestion, blood-spitting ; convulsions. When coughing while sit- 
ting, the lower extremities are jerked up. 

Sulphur, frequent relapses ; third stage. 

Tart, emet., coughing and gaping consecutively ; coughing ex- 
cited by getting angry, and by eating; vomiting of food and 
mucus after coughing. Signs of carbonized blood. 

Veratr., vomiting of tough, thin mucus, with cold perspiration 
on the forehead, involuntary discharge of urine and great ex- 
haustion; face pale and sunken; restlessness and anxiety. Spells 
brought on from entering a warm room or drinking cold water ; 
cough better when lying, worse when rising from bed. Linger- 
ing fever with lassitude, weakness, constant chilliness and great 
thirst. Fall and spring epidemics. 

Bronchial Asthma, Asthma Bronchiale Nervosum seu 
Convulsivum. 

Bronchial asthma is characterized by attacks of sudden dysp- 
noea, coming on after longer or shorter intervals, increasing 
rapidly in severity, and lasting for a few hours or for several 
days. Its nature is thought to be a spasm of the bronchial mus- 
cles (Biermer and others) ; a tonic spasm of the diaphragm (Wint- 
rich); a tumefaction of the bronchial mucous membrane in con- 
sequence of dilatation of its blood-vessels through vasomotor 
nervous influence (Weber) ; a presence of fine-pointed crystals 
found in the sputa of asthmatic expectoration, which irritate the 
peripheral termination of the vagus nerve in the bronchial 
mucous membrane, and cause a reflex spasm of the musculature 
of the smaller bronchi (Leyden). It is quite likely that in indi- 
vidual cases, these various conditions may exist singly or con- 
jointly, or may be produced either by a direct irritation of the 
vagus nerve, or in a reflex manner by irritation of various organs. 
For the first speak cases in which asthmatic and epileptic par- 
oxysms, or asthmatic attacks with hemicrania and with angina 
pectoris alternated. The reflex manner by which the bronchial 
branches of the vagus may be excited, is by far more frequent. 
We see it originate in the sexual organs (uterine asthma), in the 



ASTHMA. 381 

sensitive nerves of the intestinal tract, as in disorders of diges- 
tion, irritation from worms (dyspeptic, verminous asthma), in 
the sensitive nerves of the skin (asthma from taking cold), in the 
sensitive nerves of the mucous membrane of the respiratory- 
tract (asthma from nasal polypi) ; after measles and whooping- 
cough ; from the smell (inhalation) of different drugs (ipecacu- 
anha, yellow oak, fresh coffee, violets, lamp-black, etc.) ; of the 
pollen of certain grasses (hay asthma). 

Essential anatomical alterations on post-mortem examination 
are not found. But Stork has demonstrated by tracheoscopic ex- 
aminations that the mucous membrane of the trachea and main 
bronchi is intensely reddened during the attack. It is, there- 
fore, scarcely to be doubted, that the mucous membrane of the 
smaller ones must be in a like condition, if not more so. It is 
also clear that long continued and frequently recurring attacks 
will lead to changes which are characteristic of chronic bronchial 
catarrh, or to emphysema. 

Like all neuroses, bronchial asthma generally attacks in par- 
oxysms, the intervals between which may amount to weeks, 
months and even years. It not unfrequently commences dur- 
ing sleep ; then the patient gets restless ; the gradual increasing 
difficulty of breathing causes terrible dreams and awakens him. 
On getting awake, the patient has a desire to draw a long breath, 
but feels that the inhaled air does not reach and satisfactorily 
fill his lungs. We hear, and so does the patient, all sorts of 
hissing, whistling, and rattling noises during inspiration and 
especially during expiration. The dyspnoea increases ; the re- 
spiratory and especially the expiratory muscles labor; the alee 
nasi move up and down ; the sterno-cleido-mastoid muscles are 
put upon the stretch ; the head is drawn backwards ; the arms 
are pressed firmly upon the chair to widen the chest ; or the 
patient leans forward, resting with head and arms upon a chair 
or table; but all in vain. The vesicular murmur ceases, and 
in place of it we observe here and there a hissing noise, coming 
and going suddenly; the inspiratory noise in the larynx and 
trachea, however, continues even stronger than normal. There 
is an anxious expression of countenance ; the eyes are wide open ; 
cold perspiration covers the forehead. The color of the face is 
pale ; the impulse of the heart is violent, uneven, irregular ; the 
pulse at the wrist is weak and small ; the hands and cheeks are 
cold. After some time, varying from an hour to several hours, 



382 AFFECTIONS OF THE BRONCHIAL TUBES. 

with short intervals, the paroxysm ceases, either suddenly, when 
the air rushes into the bronchial tubes, which are suddenly re- 
lieved from spasm, causing puerile respiration, or the relief is 
only gradual, attended with belching, yawning, or increased 
secretion within the bronchial tubes, which excites cough and 
rattling of mucus for some time afterwards. 

On percussion, we will find the clear lung-sound extending on 
the right anterior side of the chest, some two inches or more be- 
low the sixth rib, showing that the inflated lung has pressed the 
liver down into the abdominal cavity ; while on the left side the 
cardiac dulness is sometimes diminished, in consequence of the 
distention of the edges of the lung. There is also only a very 
slight change of the limits of the lower edges of the lung during 
inspiration and expiration, for the reason that during expiration 
the lung cannot rid itself of the air within on account of the 
spasmodic closure of the finer bronchi. So also shows the per- 
cussion sound a tympanitic quality, usualty in the lower portions 
of the thorax, especially posteriorly and on the sides, which is 
due to the greater distention of the alveolar tissue. 

Its Diagnostic difference from spasm of the glottis lies in the dif- 
ficulty of its expiration, similar to that of bronchial catarrh and 
emphysema, while the dyspncea in croup, in oedema of the 
larynx, in stenosis of the trachea, in spasms of the glottis, and in 
paralysis of the dilators of the glottis is an inspiratory one. 

Its Prognosis is favorable. Asthma alone does not cause a 
fatal issue, but when complicated it may. It has its own remedy 
within itself. The accumulation of carbon relaxes all the mus- 
cles of the body, and, of course, the contracted bronchial muscles. 
As soon, however, as they relax, respiration is free, and the par- 
oxysm ceases. (Niemeyer.) 

THERAPEUTIC HINTS.— Apis, chest feels bruised; worse from 
heat ; nettle-rash disappears. 

Arg. nitr., must rise and walk about ; an effort to breathe deeply 
takes away the breath ; cannot talk ; drinking suffocates ; agony, 
thinks of killing himself. 

Aral., dry, whistling respiration ; cannot lie down, must sit up; 
gradual loosening and discharging of acrid mucus from nose and 
throat. (Hay asthma.) 

Arsen., paroxysms from midnight till daybreak ; has to leave 
the bed, sit up bent forward ; great restlessness and anxiety, with 



ASTHMA. 383 

feeling hot and cold in turns; fear that be will be compelled to 
destroy his own life; sweat of whole body; burning pain in chest; 
prostration; attacks from cellar-air, stormy weather, heavy atmos- 
phere, change of temperature, rapid walking. 

Bellad., paroxysms in the afternoon and evening, with sensation 
of dust in lungs ; worse in hot, damp weather, and after sleep. 

Bromium, asthma of sailors as soon as they go ashore. 

Cist, can., feeling as if the windpipe were too narrow, must open 
the window and breathe fresh air, which relieves; worse again on 
lying down. 

Carb. veg., attacks come during sleep, always after midnight ; 
must sit up by a table ; is full of wind, but cannot raise it ; for 
old people ; weakness, with trembling ; look as if dying. 

Cuprum, attacks come on suddenly and after some hours cease 
suddenly; worse at night, when coughing, laughing, leaning 
backwards and after drinking ; also before and during menses, 
after fright, chagrin, or a cold. 

Ferrum, attacks after midnight, driving out of bed ; better from 
moving slowly about and talking, from uncovering the chest. 

Graph!!, paroxysm every night, wakes him out of sleep usually 
after midnight; he has to jump out of bed quickly, must hold 
himself fast at something and quickly eat a piece of bread, after 
which the paroxysm passes off. 

Hyper., attacks return with changes of the weather from clear 
to damp, or before storms ; after lesion of the spine by a fall. 

Ipec, constriction of throat and chest ; gasps for air at the open 
window; worse from least motion; constant cough, no phlegm 
yielding, although the chest seems full of it ; cough causes gag- 
ging, vomiting, followed by relief; stiffness of the body; pale 
face ; cold extremities and cold perspiration. 

Kali carb., must lean forward with head on table ; worse from 
motion and drinking; pressure and tension in pit of stomach, 
after eating the least; belching, nausea, vomiting; puffy around 
the eyes ; dry stools ; dry skin. 

Laches., feeling of constriction in the throat and chest, as though 
a cord were tight around it, necessitating the loosening of the 
covering of the neck and epigastrium. Heart feels as if it turned 
over and ceased beating for a while, after which the pulsations 
increase. Dyspnoea worse after sleep, after eating, from moving 
the arms, and touching the throat ; cannot lie, must sit up bent 
forward with head thrown back. 



384 AFFECTIONS OF THE BRONCHIAL TUBES. 

Lobel. infl., worse from exertion ; disordered stomach, especially 
a feeling of weakness in the pit of the stomach ; asthmatic attack 
often preceded by prickling all over, even to fingers and toes. 

Mephii, inspiration difficult, expiration almost impossible; 
asthma as from inhaling vapor of sulphur ; in sleep ; of drunk- 
ards. 

Natr. sulph., in the morning about 4 or 5 o'clock, with cough 
and raising of glairy slime, and vomiting after eating; always 
worse in damp and rainy weather. 

Nux vom., for persons who drink much coffee or liquor, and 
who are very irritable ; they feel full in the pit of the stomach, 
belch a good deal, and feel better after it. Asthma worse in the 
morning, after eating, from cold air or exercise. Spasms of the 
chest from vapor of copper or arsenic. 

Opium, short inspiration, long, slow expiration with a marked 
drawing in of the epigastric region; fine rales, constant cough, 
soporous condition, bluish face ; extreme anguish with dread of 
suffocation; looks as if dying; slight relief from cold air and 
bending forward ; worse from eating, drinking wine and smoking. 

Pulsat, worse in the evening ; constant chilliness ; dizziness when 
rising from a seat; nausea and vomiting; palpitation of the heart; 
deranged menstruation; suppressed rash. 

Sanguin., asthma with hay fever. 

Sepia, long, difficult, noisy expirations. 

Silic, breathing so difficult, that eyes protrude from their 
sockets; doors and windows must be opened; always during 
thunder-storm. 

Stannum, attacks increase and decrease gradually. 

Sulphur, attacks come on every eight days. Stooping posture ; 
hunger and weakness every forenoon about 10 or 11 o'clock. 

Tart, emet, great difficulty in expiration ; must be supported in 
a sitting posture; great rattling of mucus. Children and old 
people. 

Thuja, little cough but sensation as if something were grown 
fast in the region of the left lower rib. 

Pulmo vulpis, has been recommended by Von Grauvogl in 
asthma humidum of old people when other remedies failed. 



PNEUMONIA. 385 

b. AFFECTIONS OF THE PULMONARY PAREN- 
CHYMA. 

Pneumonia. 

Catarrhal pneumonia never originates primarily in the alveoli, 
unless it be brought on by an irritant, such as chlorine, for in- 
stance, when an inflammation may arise in the alveoli and the 
bronchi simultaneously; otherwise it is always a secondary morbid 
process to bronchitis, which compare. For this reason it has re- 
ceived the name of Bronchopneumonia; and as the inflammatory 
process presents itself at first in isolated nodules, from the size of 
a pea to that of a hazel-nut within the collapsed portions of the 
lung tissue which still contains isolated portions accessible to air, 
it has also been named Lobular pneumonia. This morbid process 
may diffuse all over the lungs in the form of isolated infiltrations, 
and usually progresses from behind and below, forwards and up- 
wards. 

According to all observations its most frequent occurrence is 
found in the first three years of life, and those of old age, and as 
indirect causes we may set down all disturbances that favor the 
development of bronchial catarrh — such as measles, whooping- 
cough, diphtheria, influenza, rotheln ; sometimes typhus, variola 
and scarlatina; also foreign bodies in the bronchi and inhalation 
of gases. 

It presents no regular type of fever; the physical diagnosis is 
of great difficulty ; we must mainly rely on the presence of a ca- 
pillary bronchitis; on the consolidation of the lung, beginning 
at its base, arising slowly, at first without any prominent signs 
and mostly bilateral; on the retraction of the lower ribs seen 
during inspiration; on the indefinite limitation of the disease, 
the absence of all critical periods and the fluctuations which 
occur in general and local symptoms. 

THERAPEUTIC HINTS.— Compare Bronchitis and Croupous 
Pneumonia. 

Serous pneumonia, see Oedema of the lungs. 

Pneumonia from embolism happens only in otherwise diseased 

persons. The emboli are formed either from clots which have 

originated in the cavities of the right side of the heart, or in the 

veins of the systemic circulation. In the first place there is 

25 



386 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

disease of the heart, and in the latter their sources are either large 
external wounds, venous thrombi of the uterus in puerperal 
women, or bed sores, ulcerations and suppurations of various 
kinds. When these plugs are non-infectious, they produce mere 
heemorrhagic infarction; when they are of an infectious nature, 
they result in embolic or metastatic abscesses, which may per- 
forate into the bronchi, or into the pleural cavity, or even break 
through the chest- walls. Simple infarctions are often accompanied 
with an effusion into the pleural sac, and are much oftener found 
in the right lung than in the left. 

Croupous pneumonia, is that form which is commonly meant by 
the term "pneumonia," and consists of "an acute inflammation 
of the alveoli and bronchioles in which a fibrinous exudation is 
poured out upon the free surface of the mucous membrane, and 
there coagulates." (Juergensen.) It attacks in preference the 
inferior lobes of the lungs, especially on the right side; very 
rarely both lungs at the same time. It very rarely pervades one 
whole lung, being much oftener confined to limited portions, 
which may even be too small to be detected by percussion. It is 
also of rare occurrence that the inflammation remains confined 
to a central portion of a lobe only, (central pneumonia) but gen- 
erally spreads to the surface of the lobe which joins the pleura. 
In aged persons and cachectic individuals the posterior parts of 
the lungs are most frequently attacked. When normally pro- 
gressing, pneumonia offers three distinct stages for consideration : 
1. The inflammatory stage, or hypersemia of the capillaries in the lung 
tissue with exudation of coagulable lymph. 2. Hepatization, or infil- 
tration of the lung tissue with coagulable lymph. 3. Its resolution, or 
purulent infiltration. 

The characteristic signs of these different stages are as follows: 
First stage. As a general thing the disease sets in with a vio- 
lent chill, often attended with vomiting and followed by an in- 
tense fever, with a temperature of 104 to 105 in the evening and 
from 0.9° to 2.7° less in the morning; the pulse rises to 100 or 
110 and the respiration to 40 or 50 per minute. In other cases 
the disease sets in with several light chills or chilliness, or the 
chill is entirely absent and the scene opens with convulsions and 
complete loss of consciousness. The skin is at first very dry. but 
becomes moist usually about the third day, though only tempo- 
rarily. The face is purplish-red, and frequently only on that side 
which corresponds to the diseased side of the lungs. The lips be- 



PNEUMONIA. 387 

come covered with hidroa, (fever blisters) and also very often 
only on the affected side, or, at least, more marked on that side. 
The alae nasi make corresponding movements with respiration ; 
the voice of the patient is low and he speaks in broken sentences. 
Cough is, in almost all eases, present, although in some less marked 
than in others; the patient generally tries to suppress it, on ac- 
count of the pain which it gives. At first it is dry, but after a 
time it yields a tough, jelly-like, viscid sputum, difficult to expec- 
torate, and adhering to the lips, from which it has to be wiped 
off; it soon changes to the characteristic color of rust, from an 
admixture of blood. 

When the patient complains during the coughing spells of 
stitch-pain in the chest, it is more or less a sign that the pleura 
participates in the morbid process ; when he complains of dull, 
heavy pains, they probably originate in the bronchial tubes. 

In consequence of the disturbed circulation through the lungs, 
the blood being either not sufficiently oxygenized, or being pre- 
vented from or retarded in its return from the brain, different 
brain symptoms originate, such as delirium, stupor, etc., so that the 
case may take the appearance of typhoid fever, from which, how- 
ever, it is easily distinguished by the hidroa on the lips, which 
are scarcely ever found in typhoid fever. 

In rare cases we observe jaundice combining with pneumonia. 
In such cases the liver appears enlarged on account of the en- 
gorgement which is brought about by the impeded circulation. 
As the hepatic veins cross the gall-ducts the latter become com- 
pressed and the gall retained. In other cases it seems that pneu- 
monia is complicated with a parenchymatous inflammation of 
the liver, or a catarrh of the duodenum, causing in either case, 
icterus. 

The urine is scanty and concentrated, and deposits, on cooling, 
a sediment of brick-dust urates. The bowels are usually consti- 
pated. 

The Physical Signs at this stage are the following : 

Inspection discovers decreased mobility of the diseased side of the 
thorax. In cases where both the lower lobes are engorged, the 
patient moves only the upper part of the thorax in breathing, 
whilst the abdomen remains quiet on account of the impossibility 
to retract the diaphragm. 

Palpation shows an increased vocal fremitus, unless the bron- 
chial tubes should be stopped up by mucus. The impulse of the 
heart is also increased, but felt in its normal position. 



388 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

Percussion yields generally a short, tympanitic sound over the- 
parts involved, as long as they still contain air. 

Auscultation reveals the crepitant sound which, according to 
Wintrich, arises in consequence of the sticking together of the 
walls of the air-cells, and their separation by inspiration. 

Second stage, hepatization. The above-mentioned symptoms — 
fever heat, dyspnoea, cough, pain, and brain symptoms — continue. 
The thorax appears, on inspection, still less movable during re- 
spiration ; the vocal fremitus is strong, provided there does not 
intervene a pleuritic effusion between the hepatized lung and 
the thoracic wall. 

Percussion gives forth a dull sound, and the resistance of the 
thoracic walls to the percussing finger is increased, provided the 
hepatized portion of the lung have the thickness of about one 
inch, and a superficial extent of- several inches. A central loca- 
tion of the hepatization alters the percussion sound very little, if 
any, on account of the intervening portion of lung containing air. 

Auscultation yields neither the natural vesicular breathing, nor 
the crepitant sound of the first stage, but bronchial breathing, bron- 
chophony, and even pectoriloquy, provided the bronchial tubes, 
which are contained in the hepatized portion of the lung, be not 
stopped by mucus, blood-coagula, etc. There are also heard all 
sorts of rattling noises, if mucus exists in the bronchial tubes. 

Third stage, resolution. This sets in sometimes with a sudden 
relaxation of all the violent symptoms — the temperature falls in 
from 12 to 36 hours to the normal, and at times even below the 
normal; the congested, even purplish face becomes pale, the skin 
moist, the dyspnoea ceases, the sputa become copious, frothy, yel- 
lowish, easily expectorated ; the urine increases and becomes 
natural again. 

On inspection, we observe that the thoracic walls regain their 
natural mobility ; the percussion sound again becomes tympanitic, 
and by means of auscultation Ave observe the bronchial breathing 
and bronchophony becoming weaker; the crepitation sound re- 
appears, until, at length, the natural vesicular respiration is re- 
established. 

This is the regular progress of simple pneumonia, lasting, on 
an average, from fourteen to twenty-five days, of which two. 
three, or five days are consumed by its first development, five to 
eight days by exudation progressing to perfect hepatization, and 
seven to fourteen days by the resorption of the exudation and 
convalescence. 



PNEUMONIA. 389 

But, to the first invasion of inflammation, new invasions often 
follow, so that it is not uncommon to find in one lung all three 
stages united. 

Or, the adjoining portion of the healthy lung becomes (edema- 
tous; that is, infiltrated by a serous exudation, in which case the 
dyspnoea increases to suffocation. There is, at the same time, a 
frothy expectoration and fine rattling noises in the lung not 
affected with croupous pneumonia. The impossibility of breath- 
ing, on account of the serous infiltration, causes an accumulation 
of carbon in the blood, and, in consequence, death by suffocation. 

"Or, the disease takes an asthenic form when the symptoms of 
the central nervous system assume great prominence from the 
beginning, so that the whole process might be mistaken for men- 
ingitis or typhus; still the infiltration of the lung progresses 
slowly, and in severe cases is often attended with pleuritis, jaun- 
dice, albuminuria, and considerable enlargement of the spleen. 
This form is also called Typhoid pneumonia. 

Or, the morbid process combines with diseases of the heart, 
such as endocarditis, pericarditis, or valvular affections, all of 
which lessen a favorable prognosis considerably. 

Or, abscesses form in the third stage of the disease, which, if 
small, or deeply seated, offer no physical signs, and may dis- 
charge and heal. When large, and forming large cavities, we 
may hear pectoriloquy, and, in some cases, metallic tinkling. 

Or, the hepatization changes into tubercular infiltration, which 
is especially the case when the seat of inflammation is in the 
upper regions of the lungs. In such cases the fever does not 
leave altogether, but shows some aggravation every night; cough, 
dyspnoea and the dull percussion sound of hepatization continue, 
while auscultation reveals bronchial breathing and bronchophony. 

Or, the inflammation assumes a chronic form, and the hepatized 
lung becomes indurated or cirrhosed, the interstitial tissue growing- 
tense and rendering the air-cells impervious to air. The patient 
is almost free from fever, but recovers very slowly in strength, 
and we observe, for a long time, the dull percussion sound and 
the broncbial breathing; whilst, the thorax, in these places, 
gradually sinks' in. 

Or, the whole morbid process ends in gangrene, which happens 
very seldom, and which may be diagnosticated by the sudden 
general collapse and the cadaverous smell of the breath and ex- 
pectoration, which is dark blackish and copious. 



390 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

The mean or average time which it takes for pneumonia to 
run its course, if it is not interfered with by medicines, is, as 
above stated, twenty-five days. But this average may, by judi- 
cious treatment, be considerably shortened; for pneumonia can 
be arrested in each of its stages. The most interesting data in 
this respect have been brought forth by Dr. Eidherr, of Vienna, 
who has collected all cases of pneumonia out of a large hospital 
practice, which had been recorded there for ten years. From 
these data it appears that under the application of the sixth 
decimal attenuation of the appropriate remedies the average 
came down to nineteen, under the application of the fifteenth 
potency to fourteen, and under the application of the thirtieth 
potency to eleven days. 

The Diagnosis must be based on the above detailed physical 
signs; but one of the most constant and characteristic signs is 
the great frequency of respirations compared with the pulse, 
which in very severe cases may approach that of the pulse, 
usually, however, amounts to one respiration for two or three 
beats of the heart, while in health the ratio is about 2 to 9, that 
is 1 respiration to 4-J- pulsations. 

The most fatal days of pneumonia are those between the fifth 
and eighth days. 

THERAPEUTIC HINTS.— Sulphur, according to Eidherr, when (.ni- 
dation sets in, that is, when auscultation reveals the crepitation 
sound. 

Iodium or Kali hydr., according to Kafka, at the beginning, when 
the disease localizes itself. 

Bromium, in extensive hepatization of the lower lobes. 

Phosphor., in capillary bronchitis, or catarrhal pneumonia. 

Tart, emet., in pUuro-pneumonia. 

Schiissler recommends Perr. phosph. for the first, Kali mur. for 
the second, and Calc. sulph. for the third stage. 

All this is very well, but will not suffice for all cases; we will 
still have to consider the following: 

Aeon., first stage, high fever; must lie quietly upon the back: 
cannot lie on the right side, by stitching pains in the left. "Bais- 
ing is difficult, the expectoration being tenacious, falling in a 
round lump and of a dark cherry-red color." (C. Pearson.) 

Arnica, traumatic cases. 

:., great anxiety and restlessness with tossing about; great 



PNEUMONIA. 301 

thirst, but drinking little at a time; burning and heat in the 
chest; pale face; cold extremities; prostration. 

Baptis., "if I could only get my cough together; it seems to be 
in pieces, all scattered about, and I want to get it together." 
Typhoid form. 

Bellad., nervousness, delirium, threatening convulsions; drowsi- 
ness; inability to go to sleep; starting in sleep. Face flushed, 
eyes congested; congestion towards the brain. Dry, tickling 
cough, worse in the night. 

Bryon., expiration shorter than inspiration; inclination to lie 
perfectly still ; the slightest motion increases all the symptoms ; 
great thirst, wanting large draughts of water; desire for acid 
drinks; or little or no thirst with dryness of the mouth. Better 
on lying on the painful side; sometimes the reverse. "Expecto- 
ration falling in round, jelly-like lumps, and of a yellow or soft 
brick shade." (C. Pearson.) 

Capsic, "when coughing, the air from the lungs causes a 
strange, offensive taste in the mouth, and a badly smelling 
breath rushes out of the mouth." (A. R. Wright.) 

Carb. veg., third stage; cough by spells, or no cough; hippo- 
cratic face, eyes half open, nose pinched and cold, lips blue, 
pupils insensible, no complaining or crying; pulse small, quick, 
difficult to count; body emaciated and marbled; feet and hands 
blue and cold; abdomen distended with gas; respiration fre- 
quent and superficial; breath cold — a perfect picture of collapse. 

Chelid., right side; bilious symptoms; pain under right shoul- 
der-blade; great and quite irregular palpitation of the heart. 

Cuprum, after a previous catarrh in the chest or in the bowels; 
sudden attacks of dyspnoea to suffocation; face earthy, dirty, 
bluish, seldom red; roof of mouth always red; sweat not profuse, 
sometimes sour-smelling, without relief; diarrhoea. 

Ferr. met, no ailments previous to the chill; dyspnoea increases 
slowly; face pale, and in adults it becomes collapsed, hippocratic 
or expressionless, stiff and stupid ; the roof of the mouth always 
white ; skin neither cold nor burning hot ; pulse neither full nor 
hard; stool consistent, brown. 

Ferr. phosph., the expectoration is clear blood. 

Gelsem., after a sudden check of perspiration with pain under 
the scapula? of both sides. (A. E. Small.) 

Kali carb., cough worse towards 3 o'clock a.m., almost choking; 
pain in lower part of chest with dull percussion sound; pulse 
small and somewhat irregular; face pale; skin and stool dry. 



392 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

Kali hydr., after shaking chill, fell in a deep sleep, out of which 
he could not be roused; snoring loudly with closed eyes, injected 
conjunctiva, hot head, dry tongue, bluish lips, sunken lower jaw, 
bluish finger nails; irregular and intermitting pulse; lies upon 
his back; the extremities, when raised, fall back as if paralyzed; 
has not voided urine nor asked for any drink. Both upper por- 
tions of the lungs hepatized. (Kafka.) 

Laches., great dyspnoea, worse in the afternoon or after sleep ; 
left side ; badly-smelling stools, even if formed. 

Lycop., circumscribed redness of the cheeks ; lips and tongue 
ulcerated, red and dry ; fan-like motion of the alae nasi ; cannot 
bear to be covered; sweat without relief; cross on getting awake. 
"The patient raises a whole mouthful of mucus at a time, of a 
light rusty color, stringy and easily separated." (Pearson.) 

Merc, sol., right side; bilious symptoms; jaundice; diarrhoea. 

Nitrum, annoying feeling of heaviness in the chest, as though 
some great load were pressing the thorax together ; can drink 
only in little sips for want of breath ; dyspnoea to suffocation. 

Nitr. ac, in protracted cases; in weak, cachectic individuals, 
where there is a sudden abatement of pain, and yet an increase 
of the pulse in smallness and quickness. 

Opium, Mr. H. F., aged 40 years, of a phlegmatic temperament ; 
double pneumonia. At times feels as though he were not in his 
house, which he expresses by saying: "I wish I could be in the 
house with my family." Although in a desperate condition, he 
is not much alarmed and wants to sit up a great part of the time, 
because the bed feels too hot. His whole body, except the lower 
extremities, perspire profusely, the sweat is very hot. The perspir- 
ing parts are covered by a heavy crop of sudamina. He gropes 
with his hands about the bed as though he were hunting something. 
Inasmuch as Opium is not one of the routine remedies in pneu- 
monia, I wasted time in giving Bryon., Phosphor., etc. About the 
eleventh day Opium 6 was given, which was followed by a sudden 
change and a most satisfactory recovery, without the aid of any 
other remedy. If it is objected that pneumonia gets well without 
treatment, I reply that the time when resolution generally takes 
place had passed when Opium was given, and that in all likeli- 
hood nature was inadequate to the task in this case, where not 
only the whole left but a considerable part of the right lung was 
hepatized. I have treated another very similar case where the 
same remedy yielded the same results. (C. Bernreuter.) 



PNEUMONIA. 393 

Phosphor., "stupor with burning, hot head, red, hot cheeks, red 
ears, contracted pupils, closed mouth. Murmuring and gesticu- 
lating in delirium. Takes water, when offered, greedily, but 
cannot swallow more than one sip, on account of shortness of 
breath. Wing-like motion of alse nasi. The carotids pulsate 
violently; the heart beats strong; the pulse is very quick; the 
skin dry and hot. The lower portion of the posterior right lung 
is hepatized." (Kafka.) Great tightness across the chest; diar- 
rhoea. "The expectoration when falling on paper wdll break 
and fly like thin batter." (Pearson.) 

Pulsat, lies on the back, can't lie on the sides; semilateral per- 
spiration (left side of the chest); can scarcely speak above a whis- 
per; respiration 50 per minute. 

Rhus tox., restless moving, because lying still increases pain 
and dyspnoea; tongue red at tip. Typhoid pneumonia. 

Sanguin., second and third stage; extreme dyspnoea; tough, 
rust-colored sputa; the patient lies upon his back; there is not 
much pain in his chest, and that of a burning, stitching charac- 
ter ; pulse quick and small ; face and extremities inclined to be 
cold, or hands and feet burning, with circumscribed redness and 
burning heat of the cheeks, especially in the afternoon. 

Senega, right side; violent stitches ; sinking of strength; small, 
scarcely perceptible pulse; rare cough without expectoration, 
but great rattling of mucus in the chest; somnolence; dejected 
features. 

Sulphur, may be indicated in any stage; sometimes also when 
other remedies fail. Its indications will be found in': hot palms 
and soles; hot vertex; faint, weak spells, especially in the fore- 
noon; diarrhoea, especially early in the morning; suffocating 
spells, wants doors and windows open; restless and sleepless 
nights; cutaneous eruptions. 

Tart, emet, great rattling of mucus; much coughing, with co- 
pious, frothy expectoration, or else no expectoration; oedema of 
the lungs; impending paralysis of the lungs; greatest dyspnoea 
and fits of suffocation; cyanosis. Pleuro-pneumonia. 

Ver. vir., face flushed; red streak through the centre of the 
tongue; sinking, faint feeling in pit of stomach; regularly inter- 
mitting pulse ; expectoration of pus and florid blood. 



394 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

Pulmonary Consumption, Phthisis, 

Is the general expression for the common result of a variety of 
pulmonary affections, among which may be mentioned chronic 
pneumonia of the apex, broncho-pneumonias, bronchial chronic ca- 
tarrh, and tuberculous infiltration, all of which begin in the upper 
lobes, or apices of the lungs, and extend downwards. Inflamma- 
tory processes yield as products caseous matter, while " a cellular 
infiltration of the pulmonary connective tissue, composed of small 
nodules, absolutely bloodless, not capable of suppuration, nor of 
resorption, nor of organization, but only of degeneration," (Rind- 
fleish) constitutes tuberculous matter. The principal reasons, why 
pulmonary consumption almost always begins in the apices of 
the lungs, are : a shortening and ossification of the cartilages of 
the first ribs of scrofulous children during the early years of life 
or even congenital, and a want of .power of the respiratory mus- 
cles, constituting a paralytic thorax, laying the main burden of 
respiration upon the diaphragm ; both conditions cause a dimin- 
ished respiration in the upper parts of the lungs, and in conse- 
quence a non-removal of the secretions which form in these parts 
and become inspissated. 

Although consumption is the result of various morbid pro- 
cesses in the lungs, its characteristic symptoms nevertheless may 
be summed up as follows : 

Cough, may not always be present, or at least not in a marked 
degree in the beginning, but once present it continues to the end. 
Its severity is proportioned to the extent of the disease, and in- 
creases and decreases with the phases of the disease. Its charac- 
ter varies in different individuals, but towards the last it assumes 
a peculiar toneless sound, owing to the ulcerated state of the vocal 
cords and great muscular weakness. 

Expectoration is at first usually absent, and when it makes its 
appearance it is of no distinctive character ; later with the in- 
crease of pneumonic infiltration it becomes glassy, glutinous and 
at times tinged with blood. Still later, and in some cases earlier, 
the sputa contain opaque grayish-white striae and granules mixed 
with the rest of the yellow viscid mass. On pouring the whole 
into water the granules sink to the bottom, while the stria> re- 
main suspended ; there appear also about this time elastic fibres 
of the lung tissue in the sputa, which sink to the bottom, if the 
sputa be mixed with an equal quantity of caustic soda and be 



PULMONARY CONSUMPTION, PHTHISIS. 395 

boiled in distilled water (18 : 100), to which, under frequent stir- 
ring, water three or four times its bulk is added, and the whole 
allowed to stand and settle in a conical glass. 

Still later, and by degrees, the sputa become globular and 
compact; they sink in water or hang attached to a thread of 
mucus ; they come from cavities formed by bronchiectases, and 
as the destructive process still further progresses and cavities 
form, the sputa changes to purulent matter, which is often expec- 
torated in large quantities. 

Haemoptysis may occur at any period of the disease and is due 
either to a degeneration of the blood-vessels or to hard, straining- 
spells of coughing. It may amount to a very small quantity of 
blood, merely staining the expectoration, and it may be so pro- 
fuse that it kills the patient instantaneously. Large hemor- 
rhages take their origin from a rupture of larger vessels, mostly 
in cavities. 

Phthisis is rarely accompanied with any particular pain in the 
chest, unless accompanied with pleurisy, which causes a sharp 
stitch-pain; so also is the dyspnoea of little account, unless in- 
duced by supervening pleuritic exudation or pneumothorax; but 
the breathing is in all cases greatly accelerated and especially 
from any exertion. 

Inspection. The subclavicular region of the thorax sinks in, 
and the clavicles become prominent; the whole thorax is flat and 
elongated, and the shoulder-blades stick out; the respiratory mo- 
tion decreases or ceases altogether in those places, and in far ad- 
vanced cases the respiratory motion takes place only at the 
lower portion of the thorax. The whole bod}'' of the patient is 
emaciated, pale, and covered by a loose, thin skin. But there 
are cases where the thorax shows no such aspect, but appears 
finely developed. 

Palpation reveals stronger fremitus in one or the other sub- 
clavicular region, and in the commencement an increased im- 
pulse of the heart. 

Percussion affords, at the beginning of the disease, no results 
whatever, because minute infiltrations cannot alter the sound, as 
they are surrounded by healthy, air-containing lung tissue. 
Only when they increase in size, and thus deprive the lung of 
air, the percussion sound will grow duller accordingly, and this 
is observable most apparently in the infra-clavicular, acromial 
and supra-scapular region. If at a still later period cavities have 



31)6 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

formed, with tense, smooth walls, well adapted for reflecting 
sound, and if they are near enough to the thoracic walls, percus- 
sion may yield a tympanitic sound, or a metallic tinkling, or 
even a cracked-pot sound (if the cavity be connected with large 
bronchi), so that through percussion the air is forced out of the 
cavity into the bronchial tubes. 




TUBERCULOUS INFILTRATION 

a. Fleshy percussion si 
b and d. Short dull sou 
c. Lung sound. 
e. Heart. 
/. Liver. 



ubercti.ous Infiltration. (After Bock.) 

'. Fleshy and dull sound. 

:. Cavity with tympanitic sound, or metallic 

tinkling, etc. 
» and e. Lung souud. 



Auscultation at first yields an increased and prolongated expira- 
tory murmur, (Jackson) which is often heard in two distinct 
jerks; also fine rattling noises, which, from coughing, disappear 
only for a- little while (Niemeyer), and a systolic murmur in 
the subclavian artery on the affected side during expiration. 
(Ruehle.) 

When the tubercles commence to dissolve, we often hear the 
" click sound." 

After the lung tissue has become infiltrated by tubercular 
masses, we hear, on auscultation, bronchial breathing and bron- 
chophony, and all kinds of rattling noises. 

When cavities exist, which, with their smooth and tense walls, 
are well adapted for the reflection of sound, we hear the emphoric 
echo and metallic tinkling, also the cavernous noise. 

The pulsation of the heart is generally heard, even on the right 
side, quite distinctly. 

Phthisis is almost always attended with laryngeal symptoms, 
such as hoarseness, difficulty of swallowing (food or drink go the 
wrong way), in consecptence of tuberculous ulceration and in- 
flammation. 



PULMONARY CONSUMPTION, PHTHISIS. 397 

The circulation is accelerated; the pulse is rapid, soft and 
empty, the action of the heart is increased, causing palpitation, 
and all this at first without any corresponding elevation of tem- 
perature. In short, the signs are those of any form of anaemia, 
which ultimately develops hydremia; amenorrhcea. 

In the digestive organs we frequently meet with loss of appetite, 
in some cases even at the beginning; with nausea, occasional 
vomiting, especially after coughing, with pain or oppression in 
the pit of the stomach, in the bowels, with diarrhoea. The latter 
is of very frequent occurrence, at times showing itself at the com- 
mencement of the disease, at other times during its whole course 
in recurring spells; most commonly, however, it belongs to a 
later period, quickly exhausting the vital forces, or ending with 
a rapidly fatal peritonitis when the tuberculous ulceration ter- 
minates in perforation. 

Phthisis is at times complicated with fatty liver and amyloid 
liver, with amyloid degeneration of the spleen and of the kidneys. 

The skin is conspicuous by its transparency and paleness, and 
by the distinctness of the veins; by its great sensitiveness to the 
slightest changes of temperature ; by the easily flushing of the 
face on the slightest excitement, and the profuse perspiration 
with even moderate fever. The nails grow curved like claws, 
and there is a bulbous enlargement of the third phalanx. This 
symptom, however, is also found in other chronic diseases of the 
respiratory organs, such as emphysema, etc. The pink-red line 
on the lower gums occurs often at a very early period, though it is 
not found exclusively in phthisical persons. Pityriasis versicolor 
appears often at the very beginning. 

One of the most constant signs of phthisis is emaciation, notice- 
able from the very beginning and advancing steadily with the 
progress of the disease. During the periods of remission the loss 
is made up again, but if loss of weight should set in again with- 
out assignable cause, a renewed attack may be expected. The 
total loss produced by the disease is generally from one-fourth to 
one-third part of the initial weight, and it involves not merely 
the fat, but also the tissues and the blood. On account of this 
wasting away the disease has appropriately been called consump- 
tion. 

The fever also is a conspicuous feature of phthisis. In acute 
cases — florid phthisis — it is of a continuous type, the morning 
temperature falls but little below 102°, and the evening tempera- 



398 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

ture rises above 104°. In chronic cases it is intermitting, its 
minima are generally normal, or a little below the normal, 
while the maxima average from 101.3° to 102.2° F. 

At last must be mentioned the brilliant eyes of the phthisical 
patient and his unchangeable hopefulness even to the last. 

Its Predisposing Cause is a scrofulous diathesis, therefore 
phthisis is so frequently inherited. Still it may be acquired 
from lack of pure air, light, warmth and exercise and from a 
deficiency and poor quality of food, in short by anything that 
impairs the nourishment of the body, induces poverty of blood 
or depresses the nervous system. In scrofulous subjects these 
conditions of course will hasten the outbreak of the disease. The 
maximum of its occurrence lies between the fifteenth and twenty- 
fifth years. 

Elevated positions are known to protect against phthisis. A 
height of at least 1,000 or 2,000 feet above the sea seems to be 
requisite for this purpose. 

So also are goitre, emphysema, valvular diseases of the heart and 
considerable contractions of the chest by spinal curvatures said to 
be antagonistic to the development of phthisis, although excep- 
tions to this rule surely occur. 

As regards the contagiousness of consumption opinions have 
been at variance. Of late, however, experiments on animals 
seem to leave no doubt, that the disease is communicable, and 
cases are met where through the intimate relations existing 
between husband and wife the disease has been communicated; 
it is certainly good advice to be cautious in attending of, and 
associating with those who are far advanced in the disease. 

Consumption furnishes the largest percentage of deaths amongst 
all other diseases; nevertheless, many cases are cured, and the 
disease cannot be called incurable, though favorable conditions 
necessarily are required for a successful treatment. 

. THERAPEUTIC HINTS.— General rules, which may serve rather 
as preventives: Fresh air, and plenty of it; exercise in the open 
air, and gymnastic exercises, which tend to widen and strengthen 
the chest; methodical breathing exercises for the same purpose, 
which consist in regular, slow, and full inspirations and expira- 
tions; singing; a good and nourishing diet, and a careful atten- 
tion to the skin by rubbing and washing, in order to keep up its 
activity, and to harden it against atmospheric changes; rubbing 



PULMONARY CONSUMPTION^ PHTHISIS. 399 

the skin with olive oil has also been recommended, and a change 
of climate has certainly proved beneficial in many cases. 

About the time of puberty, all efforts should be made to pre- 
vent the excitement of sexual desires, such as reading loose lit- 
erature. Masturbation is in the highest degree hurtful; mental 
exertions, and depressions of all kinds, are also injurious. 

When catarrhal affections set in, they must be treated accord- 
ing to their special symptoms, and so also all other features, 
changes, and processes of the disease. 

When a well-selected remedy is allowed to act, it manifests it- 
self — according to Nusser's observations — generally in one of the 
following symptoms, which are favorable : 

1. Swelling of the glands in the axilla. 

2. Rheumatism in the muscles of the neck, shoulders, thorax, 
hips or extremities. 

3. Swelling of the glands on the neck and ear. 

4. The materia peccans rises from within towards the outside, 
contrary to the air which passes during respiration from without 
inward. The chest feels lighter, but the trachea and larynx 
become affected in a manner to produce hoarseness, which sub- 
siding, the nose becomes sore, and finally ends with pimples and 
pustules around the nose. 

5. The ears become affected, from mere ringing in the ears to 
suppuration within them. 

6. The eyes become inflamed. 

7. Headache and toothache set in ; in such a case, let the pa- 
tient suffer; a sudden suppression of them would quickly bring- 
back all the troubles to the chest. 

8. An eruption on the thorax, with or without itching on the 
chest or back. 

9. Sweating of the feet. 

10. Hsemorrhoidal irritations and tumors. 

11. Violent colds in the head, which may indicate Aeon, or 
Phosphor., and which almost always act beneficially. 

12. The morbid action goes down into the intestines, and 
throws out gall, acid, mucus, or gas, until finally it develops 
itself in a cutaneous disease, first attacking the head, the upper 
extremities, the thorax, and so all the way down, like small-pox. 

When a well-selected remedy brings forth any of these symp- 
toms, never disturb its action by change or repetition. 



400 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

SPECIAL HINTS. — Compare the foregoing chapters on catarrhal 
and inflammatory diseases of the respiratory organs, which may 
contain the hints just needed for the individual case. Besides 
compare : 

Aeon., intervening pleuritic stitches and blood-spitting. 

Act. rac, intercurring congestions and inflammations from ex- 
posure, with dry, harassing cough ; night-sweats and diarrhoea. 

Arsen., acute pain in the upper third of right lung; harried 
respiration upon moderate exertion, or dyspnoea on lying down; 
cough dry, or with expectoration of frothy, glairy and transpar- 
ent mucus, or yellow and grayish-yellow sputa ; cough worse in 
the evening on lying down and in the morning on rising; haem- 
orrhage from the lung with burning in the upper portion of the 
right lung. (R. R. Gregg.) Prostration; exhausting diarrhoea; 
intermitting chills, fever and sweat; thrush in the mouth. 

Ars. jod., soreness in larynx; hoarse, racking cough day and 
night with profuse purulent expectoration. (H. V. Miller.) 

Baptis., chill in the forenoon or afternoon, followed by heat and 
perspiration as in ague; general weakness and languor; some- 
times loss of hopefulness. (J. S. Mitchell.) 

Bryon., pleuritic pain and exudation; chills and fever after- 
wards; cough all day. 

Calc. carb., pain in upper half of right lung; cough with puru- 
lent sputa, worse in the morning on rising, and in the early 
evening, with paroxysms during the day, less during the night. 
Loud breathing through the nose; bleeding from right nostril. 
(Pv. R. Gregg.) Easily perspiring, with fatigue from any little 
exertion; dizziness and want of breath on going up stairs; pale- 
ness of face with frequent flushes; nightly seminal emissions; too 
early and too profuse, or suppressed catamenia; inclined to loose- 
ness of the bowels, especialty towards evening; damp, cold feet. 
" Expectoration falls to the bottom in water with a trail of tough 
mucus behind like a dropping star." (A. Fellger.) 

Carb. veg., nosebleed in the night; cough in hard spells, not 
ceasing until masses of green or yellow, or purulent and offensive 
sputa are discharged; hoarseness in the evening; cool skin; 
cold knees at night in bed; great prostration; hippocratic face. 

Cinchon., after loss of blood, long-continued nursing, seminal 
emissions; intermitting fever; sweats when dropping asleep. 

Dulcam., after taking cold from any change of weather ; tough, 
greenish expectoration, with moderate cough; stitching pain here 
and there in the chest; diarrhoea. 



PULMONARY CONSUMPTION, PHTHISIS. 401 

Ferr. met, flying pains in the chest; nosebleed; spitting of 
blood; feeling of fulness and pressure in the pit of the stomach; 
vomiting of ingesta : paleness of the buccal cavity; painless diar- 
rhoea ; watery menstruation ; hectic fever. Especially in persons 
who, in consequence of any little emotion or exertion, flush easily 
in the face, or get epistaxis, or cough, dyspnoea, spitting of blood, 
or palpitation of the heart; the symptoms are relieved by moving 
slowly about. 

Guaiac, pleuritic stitch-pains in the chest. 

Hepar, cough excited when any part of the body gets cold from 
being uncovered; chilliness in the open air; paleness after any 
exertion; perspiration easily excited; afterwards burning redness 
of the face and dry heat in the palms of the hands. After pneu- 
monia. The cough is barking, wheezing, choking, worse towards 
morning. 

Iodium, cough from constant tickling in the windpipe and 
under the sternum, with expectoration of a transparent mucus, 
sometimes streaked with blood; morbid hunger even soon after 
a meal and yet loss of flesh, or else total loss of appetite; remark- 
able sense of weakness and loss of breath in going up stairs; 
emaciation of the niammse; copious menstruation; morning- 
sweats ; dark hair and eyes. 

Kali carb., stitching pain in temples, eyes, ears, teeth, chest and 
different parts of the body; after dinner nausea, faintishness, 
sleep; about noon, chilliness; at night, heat; about 3 o'clock a.m., 
cough worse than ever. Puffmess of upper eyelids. Easily 
frightened; a slight touch of the feet causes the patient to jerk 
them up in affright; nursing mothers. "Expectoration of firm 
white globular masses of the size of a pea, flying from the mouth 
with considerable force when coughing or hawking; eruption of 
minute vesicles upon the soles of the feet with extensive itching. 
Burning in top of head and soles of feet; sweaty paleness; cir- 
cumscribed red spot on one cheek; gastric derangement with 
belching, tasting like rotten eggs; hungry and faint about 10 
a.m. ; contraction of the heel cords ; trembling sensation through 
the entire body, especially through the pelvic region." The 3d 
trituration cured whereas the 200th had failed. (0. W. Smith.) 

Laches., cough worse after sleep, sometimes only through the 
day, but also during sleep without wakening ; expectoration diffi- 
cult, has to hawk, hem, cough and spit a good while before he 
succeeds in getting a little tough phlegm away. Fever worse in 
26 



402 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

the afternoon; stools smell very offensive, even if of a natural 
consistency. Sore mouth in last stage. 

Ledum, phthisical symptoms alternating with rheumatism. 

Lycop., after neglected pneumonias, expectoration of large quan- 
tities of pus ; the expectoration tastes salty ; cough day and night ; 
hectic fever, circumscribed redness of the cheeks; worse from 
four .to eight, p.m. ; cannot bear covering ; night-sweats. 

Myrtus com., stitching pain in the left chest from the upper 
portion straight through to the left shoulder-blade, worse from 
breathing, yawning and coughing; spitting of blood. 

Natr. benz., has lately been employed successfully in consump- 
tion ; special indications wanting. 

Natr. mur„ great dryness of the mouth; follicular catarrh of 
fauces ; fluttering of the heart ; the patient gets worse on the sea- 
shore. 

Nitr. ac, patients tainted with syphilis or mercurial cachexia. 
Ulcers in mouth and throat; fetid breath; colliquative night- 
sweats, very offensive ; morning thirst ; habitual looseness or con- 
stipation of the bowels; fissures of the anus. 

01. jecor. aselli, the genuine article, which has not been "puri- 
fied" has been of great use where scrofulous diathesis is con- 
spicuous. 

Phosphor., cough worse, dry and tight before midnight, tor- 
menting; excited by talking, laughing, moving, eating or cold 
air ; during cough, bursting pain in the head, and sore burning 
pain in chest and larynx; pain in the left side of the chest; heat 
or burning in the back between the shoulders; evening chill, 
followed by heat and sweat during sleep till next morning; in 
the morning the cough is loose. Puffiness around the eyes ; diar- 
rhoea alternates with constipation. 

Phosph. ac, for young persons that have grown very fast. 

Psorin., the exhalation from the body, its secretions and excre- 
tions have an offensive odor; after suppressed itch. 

Sambuc, profuse sweats, but only while awake; during sleep 
the skin becomes dry and hot. 

Sanguin., breath and sputa smell badly, to the patient himself 
disagreeable; before and after cough, belching of wind; after the 
cough, heat, and after the heat, gaping and stretching: circum- 
scribed redness of the cheeks; diarrhoea; night-sweats; pain in 
ower left side of chest, extending upwards to left shoulder. 

Sepia, " stitching or darting pains through the central portion 



ACUTE MILIARY TUBERCULOSIS. 403 

of the right lung; cough dry in the evening; free expectoration 
in the morning, or expectoration only at night, none during the 
day." (R. R. Gregg). Cough better when lying down; the cough 
sounds loose, but there is no expectoration, or only a little after 
great efforts. 

Silic, profuse discharge of fetid pus; formation of cavities; 
profuse night-sweats; pale, wax-like appearance of the skin; 
stone-cutters' consumption. 

Spongia, cough worse from evening until midnight, from cold 
air, from talking, singing or moving; better from eating or drink- 
ing; dyspnoea on lying down with the head low. 

Stannum, feeling of great weakness in the chest ; can talk only 
a few words at a time from want of breath; pressure and bloated- 
ness of the stomach always after eating; great lassitude; hands 
and feet feel heavy and are cold, or else burning hot ; constant 
chilliness alternating with flushes of heat; profuse night and 
morning-sweats; profuse expectoration, mostly of a sweetish taste. 

Sulphur, dryness and burning in the throat; the breath appears 
hot to the patient; cough mostly dry, only now and then profuse 
discharge of purulent matter, which relieves for a while; the pa- 
tient complains constantly of being too hot, puts his feet out from 
under the cover; congestion towards the head and chest, with 
palpitation of the heart; profuse sweating at night; diarrhoea 
early in the morning; after suppressed itch or other chronic 
eruptions; pain in left side of chest in lower portion through to 
left shoulder-blade. 

Sulph. ac, stitch-pain through the upper part of the left chest 
to the shoulder-blade. 



Acute Miliary Tuberculosis. 

As the miliary tubercle can no longer be considered a neces- 
sary accompaniment of consumption, acute miliary tuberculosis 
must be regarded as distinct from phthisis, because in it the mili- 
ary tubercle forms the only, or at least, the most important lesion. 
"Acute miliary tuberculosis attacks with characteristic symptoms 
of a typhoid type both lungs, and frequently also other parenchy- 
matous organs and membranes ; the tubercle is the product of a 
very high degree of the tuberculous dyscrasia, and is deposited 
either all at once or at repeated rapidly recurring times with pe- 
riodical exacerbations of the symptoms, and in the form of the 



404 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

most delicate granulations, which have either a transparent ve- 
sicular appearance and are scarcely as large as oat grains, or are 
gray, crude, and of the size of millet seeds. The tubercles alwaj r s 
appear in great numbers; they are discrete, uniformly distributed 
throughout the pulmonary parenchyma, and only in rare in- 
stances do they become aggregated and coalesce in particular 
places, but even then there is uniformity in their distribution. 
They all exist in the same stage, viz., that of crudity. At the 
same time the lung is hyperaemic and cedematous, while its tis- 
sue has lost its compactness as a result of emphysema. The hy- 
persemia may here and there have advanced to pneumonia and 
hepatization." (Rokitansky.) Outside of the lungs the miliary 
tubercles are also found in the spleen, liver, kidneys, pia mater, 
serous membranes, and in the choroid. 

Its Symptoms are : Cough, which is never absent, but not char- 
acteristic and expectoration may be wanting, or consist of simple, 
colorless, rather viscid mucus, sometimes mixed with streaks of 
blood. 

The respiration is in almost all cases greatly increased, amount- 
ing in grown persons to from fifty to sixty, and in children to 
eighty or ninety per minute; the pulse runs up to 120 in the 
morning and during the latter part of the disease to from 130 to 
150. The temperature is usually not very high, nor does it rise 
parallel with the increase of the pulse. Towards the end the 
temperature falls and the extremities become cool and the face 
cyanotic. Auscultation reveals a general accentuation of the vesi- 
cular murmur, whistling and sonorous ronchi from apex to base, 
and at a later period crackling rales, which become more and 
more abundant. 

The disease attacks persons who are already consumptive, or 
have suffered from serious morbid processes in other organs, as a 
sudden aggravation of their symptoms, or in cases of persons of 
apparent health as an acute primary affection, usually setting in 
with a chill and subsequent high fever; assuming greatly the 
appearance of a typhoid fever, with mental dulness, vertigo, 
slight delirium, apathy, muscular prostration and sopor. The 
spleen, as a rule, is moderately enlarged. 

It is most frequently complicated with phthisis, and typhoid 
fever. In the latter case the disease develops itself either during 
the height of the fever, or follows immediately after its termina- 
tion. The differential symptoms between the two are : typhoid 



EMPHYSEMA PULMOXUM. 405 

fever has a regular type in the rising and falling of its tempera- 
ture ; shows roseola on the epigastrium and hypochondria ; and 
exhibits at times diarrhoea, meteorism, and soreness in the ileo- 
cecal region about the end of the second week and haemorrhages 
from the bowels in the third week ; while miliary tuberculosis is 
characterized by the absence of these signs and the presence of a 
disproportionate frequency of pulse and respiration relative to 
the grade of temperature. 

From acute bronchitis it distinguishes itself by the rapid loss 
of strength. 

Miliary tubercuk»sis may be inferred, also, in all cases in which 
a diffused friction murmur can be heard without any pleuritic 
symptoms. Its course is rapid and fatal. 

THERAPEUTIC HINTS.— At the commencement compare : Apis, 
Arsen., Bellad., Bryon., Calc. carb., Gelsem., Laches., Phosphor., 
Sulphur. 

At a later stage: Amm. carb., Arsen., Carb. veg., Laches., 
Opium, Tart, emet., Verat. 

Emphysema Pulmonum. 

It is an enlargement of the air-cells, either from distention, or 
from a union of several of them in one, by destruction of their 
partition-walls ; or it is a transmission of air into the interlobular, 
or subpleural cellular tissue. Accordingly, we find on post-mor- 
tem examination the lungs swell out of the thoracic cavity like 
a cushion filled with downy feathers ; and if rubbed between the 
fingers we do not feel that peculiar crepitation of a healthy lung; 
the air-cells are widened, sometimes to the size of peas (vesicular 
emphysema). In the second case, where it consists in an escape 
of air into the interlobular or subpleural cellular tissue, the 
pleura pulmonalis is raised into little blisters, which, by pressure 
with the fingers, can be shifted ; in rare cases only is the pleura sep- 
arated and filled by air to a large extent (interlobular emphysema). 

The Vesicular emphysema originates always in the neighbor- 
hood of such portions of the lungs, the air-cells of which have 
been destroyed by morbid processes, such as tuberculosis and 
interstitial pneumonia. The vacant space caused by this loss of 
substance has to be filled up by a dilatation of the neighboring 
alveoli; it is therefore of a vicarious nature, and would often 



406 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

amount to a much greater extent, were it not that the thoracic 
walls themselves sink in, and thus obliterate to a certain degree 
the vacant space caused by loss of substance inside. This same 
widening of the alveoli takes place when the two pleural blades 
have grown together to a large extent in consequence of pleuritis, 
and especially is this the case in the anterior and lower edges of 
the lungs, because the adhesion does not permit the upper por- 
tions of the lungs to extend as fully, as is the case wdien the two 
pleural blades move freely upon each other; the inspiratory act 
then overfills the lower anterior portions of the lungs and dilates 
the air-cells. The same result is effected wh«n, in consequence 
of catarrhal inflammation of the finer bronchial tubes their 
swollen state prevents the free ingress of air, or in pneumonia, 
where the sound portion of the lungs has to perform the office 
of the entire lung. But also forced expirations as during spasmus 
glottidis, spasmodic asthma, blowing wind-instruments, bearing- 
down efforts during parturition, etc., may cause dilation of the 
air-cells. 

The Interlobular emphysema originates in consequence of rup- 
ture of the alveoli. The air then escapes into the interlobular 
and subpleural connective tissue. It is mostly the consequence 
of violent coughing spells, bronchitis and croup. 

If we bring all this clearly before our minds, we can easily 
perceive the consequences Avhich must follow from such condi- 
tions. For instance, that portion of the inhaled air which occu- 
pies the distended air-cells, is never fully replaced by the acts of 
respiration, the blood coursing here remains unoxygenized. In 
the further progress of the disease still more of the air-cells perish 
as their partition-walls become destroyed, consequently still 
more of that surface is lost by which the oxygenization of the 
blood takes place, and, therefore, the insufficiency of respiration 
and the accumulation of carbon in the blood grow greater in the 
same ratio. This the patient shows by his dyspnoea, by his great 
hunger for air. He strains all the muscles to widen the thorax 
and to get breath, and, in consequence, the thorax becomes arched, 
barrel-shaped, permanently dilated, and the muscles of the neck 
voluminous. 

Another consequence, though later in appearing, is disturbed 
circulation. Hand-in-hand with the destruction of the air-cells 
goes the obliteration of the capillaries. The blood from the right 
ventricle does not find room within the lungs. Stagnation fol- 



EMPHYSEMA PULMONUM. 



407 



lows, and, in consequence, hypertrophy of the right ventricle with 
all its usual consequences, viz.: undulation of the right jugular 
vein; cyanosis of the face; varicosed veins on the cheeks and alse 
nasi; swelling of the liver; catarrh in stomach and bowels; 
swelling of the hemorrhoidal veins; scanty urine, etc. 

Its Physical Signs, on inspection, are the arched, barrel-shaped, 
permanently dilated thorax from its upper region down to the 
sixth rib. However, this condition does not obtain in all cases. 
"We find it only in those persons in whom the emphysema origi- 
nated in forced expirations and closed glottis, at a time when the 
bony structure of the chest was yet yielding. In other persons, 
with a long, flat, so-called paralytic thorax, emphysema may 




Emphysema. (After Bock.) 
leart. 6. Lang sound, c. Liver, d. Stomach. 



exist to a large extent without any such alteration of form. The 
hollow places above and below the clavicles bulge out during a 
fit of coughing, the neck appears short and thick, and the respira- 
tory motion, notwithstanding the greatest exertion, is short, su- 
perficial, and, instead of being a successive motion of the single 
ribs, is a movement of the whole surface at once, a mask-motion. 
The intercostal spaces do not bulge out; on the contrary they 
often sink in during inspiration. 

Palpation, if emphysema exists in the left lung, discovers the 
point of the heart lower down and towards the pit of the stomach, 
on account of the lower position of the diaphragm. 

Percussion affords the best pathognostic sign of emphysema, 
inasmuch as we may with certainty ascertain by it whether the 
dull sounds of the heart and liver exist in their proper places or 
not. If we hear lung sound, where We ought to hear the dull 
sound of the heart or liver, we may be sure that heart or liver 



408 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

are covered by the distended lung. Characteristic of emphysema, 
therefore, is an abnormal extension of the lung sound over heart and 
liver. Tympanitic this sound cannot be, because the air-cells are 
forcibly distended. 

Auscultation affords no very positive information. In the 
presence of a catarrh, which is a frequent complication, we 
hear no vesicular breathing, but rattling and bubbling noises. 
The inspiratory murmur is weaker, and the expiratory sound is 
wanting, unless the emphysema be accompanied by bronchitis. 

An emphysema which is confined to a small place only is not 
diagnosticable, and the interlobular and subplural form runs its 
course without any characteristic symptoms. 

The progress of this disease is always of a chronic nature, 
and its more acute attacks depend upon an increase of bronchial 
catarrhs, which, more or less, always accompany it. It usually 
ends in general dropsy, as a natural consequence of those ob- 
structions in the circulation which have been detailed above. 
The patient may live to a good age. 

THERAPEUTIC HINTS. — Compare Spasmus Glottidis, Croup, 
Whooping-cough, Bronchial Catarrh, Consumption. 

Arsen., highest degree of dyspnoea, even to suffocation, with 
great anxiety and restlessness; face cyanotic and covered with 
cold perspiration; consumptive symptoms with pain through 
upper part of right lung. 

Bellad., disturbed circulation; dizziness, headache; palpitation 
of the heart; fulness of the abdomen. 

Bromium, after pneumonia, asthma; pressure in the stomach; 
must sit up in bed at night. 

Camphora, asthma worse after any bodily exertion; cough from 
talking, inhaling of air, and a feeling of coldness, which com- 
mences in the pit of the stomach and spreads from here over the 
chest and is exhaled as cold breath. 

Carb. veg., often after Arsen. ; great dyspnoea ; cough in violent 
spells, with great anxiety, with water}-, profuse expectoration, and 
under great exertion. 

Chin, ars., regularh r every forenoon at nine o'clock attacks of 
suffocating spells in tuberculosis; limbs icy cold; cold, clammy 
sweat all over; greatest anxiety and unquenchable thirst: must 
sit up, bent forward, if possible, at the open window. 

Chlorine, easy inhalation ; exhalation impossible. 



HYPEREMIA AND (EDEMA OF THE LUNGS. 409 

Cuprum, asthmatic symptoms worse after walking against the 
wind. 

Digit., complications with heart disease; better in lying per- 
fectly quiet in a horizontal position. 

Hepar, combined with bronchial catarrh, worse from slightest 
exposure; coughs from midnight till morning; sleeps with head 
thrown back. 

Ipec, dry, spasmodic cough of old people; collection of mucus; 
difficult to expectorate, and giving only temporary relief; nausea. 

Kali carb., dyspnoea worse at night; strong beat of the heart; 
loss of appetite ; vomiting; dry skin. 

Laches., all covering around the neck and even chest unbear- 
able; worse after sleeping; cough torturing until some little 
tough phlegm is raised; stool smelling badly; follows well after 
Arsen. and Carb. veg. 

Lobel. hub, inclination to sigh and take a deep breath. 

Naphthal., recommended by V. Grauvogl for emph} r sema in 
consequence of forced expirations in buglers, etc., and after 
bronchial asthma without catarrh. 

Opium, nightly asthma, with whizzing and rattling during 
expiration, which is long and attended with retraction of the 
epigastric region ; inhalation short, without noise. 

Sarsap., asthma worse after eating or motion. 

Seuega, feeling as though the thorax were too narrow, with con- 
stant inclination to widen it by deep inhalation; burning in the 
chest. 

Sepia and Sulphur, both worse after sleep; getting suddenly 
roused by asthma from a deep sleep. Difference between both, 
see Gross' Comparative Materia Medica. 

Tereb., asthma worse from motion. 

Besides these compare Aspar., Bryon., Lobel., Natr. mur., Nux 
vom., Pulsat., Tart, emet, Veratr., and all that is mentioned 
under Asthma Spasmodicum. 

Hyperemia and (Edema of the Lungs. 

This affection consists of a serous exudation into the air-cells 
and finest bronchial tubes of the lungs, and is either acute or 
chronic. Sometimes it is confined to a small portion, and some- 
times it extends over both lungs. When acute, the lung appears 
strongly injected with blood, tense, leaving no dent on pressure; 



410 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

when cut in two there oozes out of it a bloody serum, which con- 
tains a great deal of albumen. All the air is driven out by the 
serum, and the lung tissue is easily torn. On account of this 
similarity with pneumonia, acute oedema is also called Serous 
pneumonia. 

In chronic oedema the lung appears pale and tough ; upon press- 
ure a dent remains; the serum is pale-yellowish, thin, and con- 
tains little albumen; it fills the air-cells and finest bronchial 
tubes. The lung is heavy and puffed similar to any dropsical 
swelling, and it is deprived of air as far as the infiltration of 
serum extends. 

The acute form is generally the product of hyperemia or active 
congestion — a fluxion of blood to the lungs, which may be caused 
1, by an increased action of the. heart, during the period of puberty, 
or in consequence of passions, or bodily exertions, or the use of 
stimulants; or, 2, by direct irritations from inhaling cold air, or 
hot and irritating substances; or, 3, by obstruction of the free cir- 
culation in some portions of the lungs by pleuritic effusions, 
pneumonic or tubercular infiltrations — producing a collateral 
fluxion. 

The chronic form is generally the product of stagnation in con- 
sequence of heart diseases, especially of stenosis and insufficiency 
of the mitral valves; also of a weakened action of the heart due 
to asthenic fever in the course of acute exanthemata, typhoid or 
puerperal fevers, etc., to fatty degeneration of the heart, or myo- 
carditis. 

Its most prominent Symptoms are : 

1. Dyspnoea, which oftentimes reaches such a height that the 
patient, in the greatest distress, tries all possible positions to get 
breath — now sitting erect, now bending forward and supporting 
the head with the arms, etc. 

2. Spasmodic cough with a great deal of frothy and serous, some- 
times bloody expectoration. 

3. Cyanotic symptoms, in consequence of the obstruction to the 
circulation; and finally, if the breathing is still more impeded, 
and the blood becomes overcharged with carbon, 

4. The patient sinks, his cheeks grow livid, and he dies of as- 
phyxia — Apoplexia pulmonum vascularis. 

Physical Signs. — Inspection and palpation show, notwithstand- 
ing the greatest efforts of the patient to draw in air, a decrease in 
the respiratory motion of the thoracic walls. 



GANGR.ENA pulmonum. 411 

Auscultation reveals all sorts of rattling and bubbling noises, 
at times a weak crepitant sound. 

Percussion, however, gives no results, unless the lung has be- 
come deprived of air to a large extent, when, of course, the sound 
is dull, or tympanitic, when the lung tissue becomes compressed, 
so that it loses its natural elasticity. 

THERAPEUTIC HINTS.— In acute oedema, compare Aeon., Nux 
vom., Scilla, Sulphur, Tart. emet. 

Amm. carb., somnolence; poisoning of the blood by carbon. 

Arsen., great anxiety; restlessness; always worse towards mid- 
night or soon after. 

Carb. veg., collapsed state. 

Cinchona, after debilitating losses. 

Ipec, spasmodic cough ; sickness of stomach ; fine rattling noises 
in the chest. 

Kali hydr., sputa like soap-suds. 

Laches., suffocating fits; worse after sleep; dark, almost black 
urine ; offensive discharge from the bowels. 

Phosphor., if worse before midnight, with tightness in the chest. 

Tart, emet, large bubbling rattling; chest appears full of phlegm 
without capability of relieving itself. 

Besides may be indicated: Aurum, Bellad., Cactus, Cimicif, 
Gelsem., Glonoin., Sanguin., Spongia, Ver. vir. 

Compare Asthma, Pneumonia, Heart Diseases. 

Gangrsena Pulmonum 

Is a process of mortification and putrifaction of the lung tissue, 
owing to the admission of air, as it occurs in all lifeless animal 
tissues when under the influence of air, moisture and a certain 
temperature. It is either circumscribed — that is, confined to one 
or several foci of various sizes — or diffused, without accurate lines 
of demarcation; the first form may degenerate into the latter. 

Its Causes are : interruption, or weakness of the blood-currents, 
by pneumonic infiltrations or emboli; putrid suppuration in the 
neighborhood of the air-passages by perforation into a bronchus ; 
decomposing foreign bodies, which have found their way into the 
lung through the trachea; putrid contents collected in dilated 
bronchial tubes ; injuries caused by stabs or gunshot wounds. 

Its most characteristic symptom is the sputum, which consists 



412 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

of a greenish-gray or brownish-colored fluid, with an exceedingly 
offensive smell. The breath, too, or forced expiration, exhibits 
the same disgusting smell. There is almost always a racking 
cough attending the disease, and dangerous haemorrhages may 
ensue from the gangrenous erosion of blood-vessels. The tem- 
perature is usually very high. The diffused form runs a very 
rapid course with all signs of an asthenic fever, delirium, stupor, 
hiccough, colloquative diarrhoea and collapse. Physical exami- 
nation yields at first generally a tympanitic sound on percussion, 
which at a later period grows dull. Small gangrenous masses, 
or larger ones, which do not communicate with a bronchus, or 
which, from some other cause, cannot discharge their contents, 
are out of reach of diagnosis. The circumscribed gangrene may 
discharge and heal ; the diffused form usually is fatal. 

THERAPEUTIC HiNTS.— Compare : Arsen., Carb. veg., Carb. ac, 
Kreosot., Silic. 

Haemorrhages of the Lungs, Haemoptoe, Haemoptysis. 

Haemoptoe — haemorrhage of the respiratory organs, Haemoptysis 
— expectoration of blood, consists either of mere exudation of 
blood-corpuscles through the uninjured walls of the capillaries — 
Diapedesis, — or of a pouring out of blood through ruptured vessels. 

Haemorrhages occur most frequently in the smaller and ter- 
minal bronchi — Bronchial haemorrhages ; parenchymatous bleeding 
is less frequent, and is either confined and sharply outlined, with- 
out destruction of the parenchyma — Haemorrhagic infarction, — or 
is diffuse, abundant and associated with destruction of the lung 
tissue, and causing the formation of cavities — Pulmonary apoplexy. 

Bronchial haemorrhages may be caused in the main by all such 
morbid conditions as will produce either articc or passive conges- 
tion of the bronchial mucous membrane, for instance: bronchitis, 
whooping-cough, pneumonia, tuberculous infiltrations, acute ex- 
anthemata, inhalation of irritating gases, excessive heat or cold, 
severe strains and bodily exertions, suppression of menstrual or 
hemorrhoidal flows, disorders in the circulation resulting from 
heart disease, and peculiar altered conditions of the blood, which 
impair the nutrition of the vascular parietes, and manifest them- 
selves in scorbutus, haemophilia, scarlatina, typhus, variola, etc., 
also in bleedings from other portions of the body. 



HAEMORRHAGES OF THE LUNGS. 413 

Haemorrhagio infarctions are most frequently due to organic 
heart diseases, especially of the right heart, to pulmonary em- 
physema, senile or early acquired atrophy of the lungs and 
thrombosis of the peripheric veins of the body. 

Pulmonary apoplexy arises from the rupture of large, generally 
arterial vessels, most frequently in consequence of injuries, gun- 
shot and penetrating wounds, contusions and concussions of the 
thorax; rarer from endarteritis and aneurismal changes of the 
walls of the pulmonary arteries, or their erosion by cancer, ab- 
scesses and pulmonary gangrene. 

In order to decide whether the blood comes from the nose, 
larynx or trachea, a close inspection of these parts will best de- 
cide. If in doubt whether the haemorrhage comes from the stom- 
ach, we will have to inquire about the conditions of the digestive 
organs and those of the portal circulation. 

Small haemorrhages issue usually from capillaries, profuse ones 
from a large vessel ; Hemorrhagic infarction is, as a rule, associated 
with a high degree of dyspnoea, the physical signs of a circum- 
scribed pulmonary solidification and heart disease. Pulmonary 
apoplexy kills, so to say, at the spot. 

THERAPEUTIC HINTS.— Aeon., in many cases; but best indicated 
by restlessness, agitation, fright, expression of anxiety in the face, 
palpitation of the heart, congestion towards the chest and head, 
fear of death; after wine. The blood comes hot and fresh with 
every little cough. 

Arnica, after mechanical injury ; from slight, bodily exertion ; 
in tuberculous individuals ; constant tickling cough, starting 
either from the larynx or from under the sternum. 

Arsen., after venesection, or loss of blood otherwise ; great weak- 
ness and fainting ; restlessness, must walk about ; burning in 
chest and stomach ; suppressed menstruation. 

Bellad., cough from constant tickling in the larynx ; congestion 
to head and chest ; stitching pain in chest, worse front motion ; 
suppressed menstruation. 

Cact. grand., with heart disease. 

Carb. veg., pale face ; cold skin ; slow pulse, intermitting, scarcely 
perceptible ; mostly attended with violent cough in paroxysms and 
hoarseness, worse towards evening ; sometimes burning in chest. 

China, after great loss of blood or vital fluids ; during nursing, 
etc.; with all the signs of weakness which arise from want of 
blood ; continual pain in chest and stomach, worse from touch. 



414 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

Collin., blood dark, tough, coagulated, enveloped in viscid 
phlegm ; previous discharge of blood per anum ; subsequent 
costivcness. 

Conium, especially after masturbation. 

Croc, sat, blood dark and stringy. 

Digit, haemoptysis before menstruation with pain in the chest, 
back and thighs ; from obstruction of the pulmonary circulation 
in consequence of heart disease and tuberculosis. Engorged 
veins about the head, pale, livid complexion, coldness of skin 
with cold sweats, irregular pulse and palpitation of the heart. 

Eriger., dark coagula, passive haemorrhage. 

Ferrum, always better from walking slowly about, notwithstand- 
ing weakness obliges the patient to lie down ; quick motion and 
talking bring on cough ; there is pain between the shoulders ; 
the face has a yellowish tint ; sleep is poor at night, and there is 
frequent palpitation of the heart. 

Hamam., blood is venous ; comes into the mouth without any 
effort, seemingly like a warm current from out of the chest ; 
mind calm ; sometimes taste of sulphur in the mouth. 

Iodium, annoying tickling cough in phthisical persons ; oppres- 
sion and palpitation ; trembling and coldness of the extremities. 

Ipec, blood frothy and bright colored ; gasping for breath, pulse 
small and frequent ; face livid and anxious. 

Led. pal., where there is stagnation in the liver and portal veins : 
congestion towards the head and chest ; hardness of hearing ; 
tickling in the larynx ; spitting of bright red blood. Haemopty- 
sis alternating with rheumatism. 

Millef., in tuberculosis. It bubbles up in the chest as if warm 
blood were ascending, which is raised without cough. After in- 
juries. 

Myrt. com., in phthisical persons ; sharp pains through the upper 
part of the left lung, from front to shoulder-blade. 

Nitr. ac, according Goullon the best remedy. 

Nux vomr, especially after high living, suppressed haemorrhoidal 
discharges, and after fits of passion, etc. 

Opium, blood is thick and frothy, mixed with phlegm ; absence 
of all pain ; slumber, with starting. 

Phosphor., vicarious spitting of blood for the menses ; tubercu- 
lar diathesis, dry tight cough, worse from evening until mid- 
night ; bronchitis. 

Phosph. ac, phthisis; typhoid fever, with diarrhoea and great 
rumbling in the bowels; fast growing youths. 



PLEURITIS, PLEURISY. 415 

Pulsat., dark, coagulated blood; chilliness; loose stools; sup- 
pressed menstruation ; crying spells. 

Rhus tox., after straining, lifting, blowing of instruments, or 
worriment and mental excitement immediately renewed ; blood 
bright. 

Senec, in suppressed menstruation ; after venesection. 

Sulph. ac, in climacteric period; also habitual haemoptysis ex- 
cited from least fright, vexation, talking, running, in persons 
who flush easily, have palpitation, perspire easily, are easily ex- 
cited. Also in scorbutic, alcoholic affections, adynamic fevers, 
tuberculosis. 

Stanmim, in phthisical patients, when at the same time there 
exists copious expectoration. 

Tart, emet, when, after the attack, there remains for a long time 
a bloody, slimy expectoration. 

In suppressed menses, compare Arsen., Bellad., Millef., Phos- 
phor., Senec, Sulphur. 

After the suppression of habitually bleeding hxmorrhoids, compare 
Aeon., Nux vom., Sulphur. 

After wine, Aeon. 

After whiskey, Pulsat., Mercur. 

After coffee, Nux vom. 

c. AFFECTIONS OF THE PLEURA. 
Pleuritis, Pleurisy, Inflammation of the Pleura. 

When we examine, post-mortem, a case of pleurisy, we observe 
on the pleural surfaces, pinkish dots or streaks here and there, 
consisting of enlarged capillaries, also irregular, dark red, ecchy- 
mosed patches of extravasation. The surface of the pleura, in- 
stead of being smooth and shining, appears dull and swollen, 
rough and villous from fine granulations and new cells upon it. 
This is the most frequently occurring form of pleurisy without 
exudation, and therefore called pleuritis sicca, dry pleurisy. 

In other cases, we observe, in addition to the above-stated 
features, which are, in fact, the ground-type of all forms of 
pleurisy, a scanty fibrinous exudation, covering, like paste, or (if in 
greater abundance) like a soft, croupous membrane, the inflamed pleural 
layers. During the progress of recovery it gradually becomes 
dissolved by a fatty metamorphosis and is absorbed; but those 



416 AFFECTIONS OF THE PLEURA. 

fine granulations and new cells which lie underneath, and which 
are inherent parts of the inflamed pleura, frequently give rise to 
adhesions of the pleural surfaces. This fibrinous exudative pleu- 
risy accompanies almost always croupous pneumonia. 

In still other cases we observe an abundant serous fibrinous 
exudation, varying in amount from a few ounces to ten or more 
pints. It consists of a greenish-yellow serum, of coagulated fibri- 
nous masses and pus corpuscles, which partly float in the serum 
and partly are deposited upon the pleural surfaces, where they 
adhere like croupous membranes. At times the pus corpuscles 
are in such abundance, that the exudation assumes a purulent 
character; and when from rupture of the finer blood-" vessels, or 
simply by transudation in consequence of a hsemorrhagic diathe- 
sis, large masses of blood-corpuscles mix with the exudation, we 
have a hemorrhagic effusion. In consequence of, and according 
to, the mass of the pleuritic effusion, the lung of the affected side 
becomes compressed at times to the fourth, sixth, or even to the 
eighth part of its normal volume; its arched costal portion is 
flattened down, and its substance appears pale reddish, or bluish- 
gray, or lead colored, and becomes tough like leather, bloodless 
and airless. Heart or liver become displaced accordingly, as the 
effusion is either on the left or right side. The sound lung al- 
ways shows more or less congestion, and in fatal cases a collateral 
oedema of high degree. 

In case of recovery the exudation is gradually absorbed, fre- 
quently leaving yellow cheesy masses behind, which are residues 
of unabsorbed pus-globules and fibrinous substances. 

In the same degree in which absorption takes place, the lung 
regains its normal volume and condition, provided the air-cells 
be not glued together, or closed by fibrinous deposits. In these 
conditions air cannot enter, and the lung, or such part of the 
lung, cannot regain its normal expansion. This would cause a 
vacuum in the thorax, were it not for the pressure of the external 
air, which at once flattens down the corresponding portion of the 
thoracic walls, or pushes heart or liver higher up into the thoracic 
cavity. 

The purulent exudation, which is so rich in pus-globules that it 
forms an opaque, yellow, thickish fluid, is called empyema or pyo- 
thorax. Even in such cases absorption is possible. Should, how- 
ever, the pleural substance in consequence of the suppurating 
process be softened and perforated, the purulent matter would 



PLEURITIS, PLEURISY. 417 

then escape either through the thoracic wall, in case the pleura 
costal is were destroyed, or through the bronchial tubes, if the 
pleura pulmonum were perforated. 

These four different forms of pleurisy must of course manifest 
themselves by different symptoms. 

The first form Pleuritis sicca, when, in consequence of inflam- 
mation, new cells form upon the pleural surfaces, but without 
(■.nidation, seems to take place frequently without any particular 
signs. This statement is founded upon the existence of many 
adhesions, found in post-mortem examinations, in persons who 
had never complained of symptoms that could possibly have been 
taken as indications of pleurisy. 

The second form, with Scanty fibrinous exudation, is generally 
coupled with pneumonia or tuberculosis. It is characterized by 
a sharp stitching pain, which hinders deep inspiration, coughing, 
sneezing and motion, and for this reason the patient can breathe 
only superficially. If not complicated with pneumonia or tuber- 
culosis, there is scarcely any cough attending it. 

On inspection we observe, in consequence of the pain which is 
caused by breathing and moving, that the patient bends his 
body towards the affected side, in order to bring the ribs of that 
side nearer together to prevent their respiratory motion , in con- 
sequence of which the spine itself becomes curved, its convexity 
being directed towards the sound side. 

Palpation merely confirms the superficial breathing, and may 
yield the perception of a grating feel; more, however, towards 
the end than at the commencement of the disease, after the 
exudation has been absorbed, when, therefore, the surfaces are 
dryer and the breathing deeper again, so that the rough surfaces 
glide more forcibly one upon the other. 

For this same reason, auscultation reveals the friction sound 
more decidedly towards the end of the disease. 

The third form, with Abundant serous-fibrinous exudation, usually 
commences with a strong chill, followed by high fever. The chill 
is frequently repeated, and the whole affection may look very 
much like a tertian intermittent fever. It is also characterized, 
like the second form, by violent stitching pains in the sides of the 
chest, which, however, often subside, or at least diminish, before 
the inflammation and exudation have reached their full height. 
The subsidence of pain is therefore, in this form, not always a 
sign of conquered disease. 
27 



418 



AFFECTIONS OF THE PLEURA. 



Generally it is accompanied by dyspnoea as long as the fever 
lasts, and in such cases, and where an extensive exudation com- 
presses the lung, and causes a hypersemic state and catarrh in 
the adjoining portions of the lung, there is also cough. Other- 
wise the cough may be absent altogether. 

The disease generally reaches its height in about six or eight 
days, and commences its gradual decline from that time. Fever, 
pain and cough cease, and absorption of the pleuritic exudation 
takes place, diminishing at first much more rapidly than towards 
the last, so that sometimes, even after weeks, some fluid can still 
be detected. 

In some cases this form comes on quite stealthily, without 
either prominent fever, pain or cough. The patient feels only a 
gradual loss of strength, some difficulty of breathing; he grows 
pale, and loses flesh, and thinks that the source of all his troubles 
lies in his abdomen, especially when, by exudation on the right 
side, the liver has become dislocated downwards. Even the 
physician may be astonished when he, by closer examination, 
finds the whole pleural sac filled with fluid, amounting to from 
ten to fifteen pints. Such an enormous quantity, of course, can 
be absorbed at best only very slowly, being alternately augmented 
and decreased in the meantime. It terminates finally, in a great 
number of cases, in tuberculosis. 




Exudation on Rhiht Side. (After B 
a. Exudate. 
6. Heart, 
e. Compressed lung with tympanitic 

d. Lung sound. 

e. Displaced liver. 



Exudation ox Left Sidb. (After Bock.) 
n. Exudate. 

b. Displaced heart. 

c. Compressed lung with tympanitic sound. 
d Right lung with normal sound. 

e. Liver. 



Inspection discovers an enlargement of the thorax in breadth 
and depth on the diseased side, if the exudation is sufficiently 



PLEURITIS, PLEURISY. 419 

large. The intercostal spaces are wider, and are on a level with 
the ribs, or even bulging out between them. The respiratory 
motion is much less, or ceases altogether on the diseased side. 

Palpation reveals the absence of the vocal fremitus, which is the 
necessary consequence of the intervening fluid between the 
thoracic walls and the lung; it reveals dislocation of the heart or 
of the liver, and also sometimes the friction of the roughened 
pleural surfaces above the exudation. 

Percussion yields a somewhat duller sound, in case the exudation 
be moderate, so as not to compress the lung tissue to such a 
degree as to drive all air out of it; it yields a tympanitic sound if 
the pressure upon the lung be just sufficient to deprive it of its 
natural tension and elasticity; it yields a dull, fleshy sound if the 
secretion augments to such a degree as to deprive the lung of all 
the air; above this dull sound we hear again the tympanitic sound, 
for here the lung, although compressed, is not entirely without 
air. Variation in position does not change the result of percus- 
sion, because the exudation is usually enclosed and bordered by 
adhesions. 

Auscultation reveals an absence of the respiratory murmur over 
the whole part that is covered b}' exudation. In other cases, 
however, we hear a loud bronchial breathing all over the thorax, 
especially in case of dyspnoea ; no matter how much fluid inter- 
venes between the thoracic walls and the lungs, or how much 
the lungs may be compressed. The auscultatory signs are there- 
fore not very characteristic. 

The fourth form, Empyema or Pyothorax, differs from the latter 
only by the abundance of its pus-globules, and is frequently 
found in consequence of infectious diseases and a general pysemic 
condition. Its physical signs are all the same as above stated. 

When empyema is going to discharge through the thoracic walls 
we observe in the region of the fourth or fifth rib an cedematous 
swelling, which soon changes into a hard, tense swelling, pro- 
truding from between the ribs ; by and by it becomes fluctuating, 
and lastly it bursts and discharges an immense quantity of pus. 
This opening sometimes remains for years, forming a thoracic 
fistula, and discharges every now and then larger or smaller 
quantities of pus. 

When empyema is going to discharge through the bronchial 
tubes there may appear at first, symptoms of pneumonia, or the 
bursting takes place suddenly, when, with violent fits of cough- 



420 AFFECTIONS OF THE PLEURA. 

ing, the patient throws up large quantities of pus. Even here 
recovery is possible, though it may happen that the patient suffo- 
cates, or sinks under the influence of pysemic poisoning of the 
blood. The empyema may also discharge downwards through the 
diaphragm into the abdominal cavity, where it occasions a violent 
peritonitis. 

When the course of pleuritis is very acute, the morning and 
evening temperatures rise to above 104° F., and the pulse to 120 
and higher; there is frequently great disturbance of the senso- 
rium, often violent delirium, great dryness of the tongue, exces- 
sive thirst and total loss of appetite; the anterior extremity of 
the spleen, even in the early days, can be distinctly felt, and di- 
arrhoea may set in at this time, thus simulating a case of typhoid, 
though the deeply cyanosed complexion, the constant abnormal 
elevation of temperature and pulse and the physical examination 
will soon correct an error of this kind. 

When in the first week of illness an unusual pallor presents 
itself, accompanied with rapid loss of strength, high fever and a 
considerable degree of pain in the affected side, we may assume 
that a hsemorrhagic exudation has taken place in consequence of 
a tubercular pleuritis in young persons; in old people the same 
symptoms hint to a tendency of the exudation to become purulent. 

When the inflammation attacks the diaphragmatic portion of 
the pleura — known by the ancient physicians under the name of 
paraphrenias, then the pain is usually in the hypochondriac re- 
gion, about the cartilages of the false ribs, at the level of the dia- 
phragm; the respirations are short and quick, the inspiratory 
expansion is confined to the upper ribs, the body is inclined for- 
wards, the countenance is much altered, with twitchings about 
the lips and occasionally rims sardonicus; there is also, at times, 
hiccough, nausea and even actual vomiting. Still, these symp- 
toms are not constant; there are cases of diaphragmatic pleurisy 
without the one or the other of these signs, or they appear in 
consequence of inflammation of one or more of the organs lying 
beneath the diaphragm. 

Pleurisy may become complicated with many acute and chronic 
diseases, such as : pericarditis, tuberculosis (when it usually ap- 
pears simultaneously on both sides), pneumonia, bronchial ca- 
tarrh, inflammation of the mediastinum and of the peritoneum (in 
purulent pleuritis), caries of the ribs and spine (also in its puru- 
lent form), scarlet fever, measles, small-pox, articular rheumatism. 



PLEURITIS, PLEURISY. 421 

Its Sequelae are: adhesions of the two pleural layers, inveter- 
ate bronchial catarrhs, caseous pneumonia, bronchiectasis, etc. 

The Differential Diagnosis between Pleurisy and Croupous 
pneumonia is : 



Pleurisy. 
Repeated chills. 
Catarrhal sputa. 
Stitching pain. 



Enlargement of the thorax. 
Absence of vocal fremitus. 



Pneumonia. 
One chill. 

Rust-colored sputa. 

No pain or dull when the bronchial tubes, 
and stitch-like when the pleura is in- 
volved. 

None. 

Increased vocal fremitus. 



Dislocation of heart, liver, or spleen. None. 

Friction sound. ' Crepitant sound. 

Its Prognosis varies greatly according to its character. As 
unfavorable signs Fraentzel considers the following: "1. A double- 
sided pleuritis, as it almost always indicates tuberculous disease 
of the pleura. 2. Continued high fever. 3. Rapid increase of 
the effusion, accompanied with high fever and with great dis- 
placement of adjacent organs, unless, after a course of from four 
to six weeks, signs of commencing absorption are observed. 4. 
Symptoms of impending suffocation. 5. Discharge of the pus 
either into the bronchia, with simultaneous production of pyo- 
pneumothorax, or externally through one of the intercostal spaces. 
. 6. The rapid increase of an effusion which has for a long time 
remained stationary, because in that case the pleuritis, as a rule, 
has assumed a tuberculous and hemorrhagic character. 7. A 
rapid return or increase of the effusion after spontaneous, or a 
single or repeated artificial discharge of the same, especially 
where the quality of the discharged fluid degenerates and be- 
comes purulent, bad-smelling, ichorous, chocolate-like, etc." 

THERAPEUTIC HINTS.— Aeon., chill; fever; great thirst; quick 
pulse; dry skin; anxious restlessness; agonizing tossing about; 
stitching pain in chest; inability to lie on the right side; dry, 
hacking cough. 

Arnica, after mechanical injuries ; bruised feeling in chest ; ex- 
pectoration of bloody foam. Is followed well by Sulph. ac., in the 
traumatic form. Nervous persons; torpidity even to sepsis; dry, 
cold extremities; head hot, remaining body cool; constant change 
of position on account of a feeling as though the bed were too 
hard. 



422 AFFECTIONS OF THE PLEURA. 

Arsen., profuse serous effusion ; great dyspnoea and little pain ; 
weak and cachectic persons; drunkards; intermittent parox- 
ysms ; pyothorax. 

Bellad., when the inflammation ascends from the diaphragm ; 
plethoric, lymphatic persons, tuberculous women with affections 
of the cerebral membrane ; in exanthematic, typhoid, puerperal 
phlogosis ; after scarlet fever. 

Bryon., stitching pain in chest, worse from slightest motion; 
better when lying on the affected side, not always however; 
tongue white ; thirst great. 

Calc. carb., has rapidly diminished the pleuritic exudation. 

Cantliar., profuse serous exudation; frequent cough; dyspnoea; 
palpitation ; profuse sweats ; great weakness ; tendency to syn- 
cope ; scanty urine. (E. Faivre.) 

Carb. veg., prostration; sunken features; sallow complexion; 
emaciation ; hectic fever ; purulent or ichorous degeneration. 

Colchic., arthritic form; sour smelling sweat not alleviating; 
scanty, turbid, red urine with acid reaction and containing al- 
bumen. 

Hepar, croupous exudation with a yellow or yellowish-brown 
tint in face, in scrofulous and lymphatic persons; hectic fever 
with intermittent paroxysms; empyema. 

Kali carb., when the violent stitching pain does not yield to 
Bryon., especially on the left side with violent palpitation of the 
heart; the cough is dry and worse towards three o'clock, a.m. 
Pain in epigastrium ; throbbing and stitching pain in back up 
to the nape of the neck. 

Kali hydr., in croupous exudation. 

Lauroc, for drunkards and melancholic persons at the begin- 
ning with continual suffocating cough ; the pain in the pleura is 
severe and localized ; pulse soft though quick. 

Mercur., in syphilitic or rheumatic patients when the pain per- 
sists after the fever, with copious, not alleviating sweats ; frequent 
chills (feels chilly whenever moving the feet to a cooler place in 
bed) ; considerable thirst ; gastric and intestinal catarrh with 
icterus. Stitching pain through to the back when coughing or 
sneezing ; right side. 

Nitr. ac, for old people, when the pain leaves and the pulse in- 
creases ; great weakness and diarrhoea. 

Pbosphor., in complications with bronchitis; tightness across 
the chest ; dry, tight cough, which is worse from evening until 



PLEURITIS, PLEURISY. 423 

midnight. Later stages ; purulent infiltration ; hypertrophy of 
the right heart; Blight's disease. 

Rhus tox., after exposure to wet, or from straining, lifting, 
wrestling, etc. ; tip of tongue red ; fever-blisters around the mouth 
and nose ; very restless notwithstanding the pain. 

Senega, after the inflammation has passed ; copious, mucous se- 
cretion with difficult expectoration; tightness and burning in 
the chest. 

Sepia, recommended by Kunkel on the ground of the symp- 
toms 1005 to 1190 in Hahnemann's Chronic Diseases. 

Squilla, stitching pain in left side; short, rattling cough, dis- 
turbing sleep ; inability to lie on the left side ; grating of teeth ; 
twitching of the lips which are covered with thick yellow crusts, 
more on left side ; cheeks bright red ; perspiring profusely espe- 
cially on forehead ; red tip of tongue, yellowish covering on the 
back part. 

Sulphur, when the pain is in the left side, lower region, going 
through to the shoulder-blade, and of a more steady nature; lips 
bright red ; in connection with acute articular rheumatism or 
gout ; fibrinous pleuro-pneumonia. Follows well after Bryon. or 
Rhus tox. 

Tart, emet, in pleuro-pneumonia at the commencement, accord- 
ing to Kafka, specific. Dyspnoea, must sit up ; palpitation ; tin- 
gling and pinching in the pit of the stomach. When the healthy 
side is attacked by oedema. 

In neglected or badly treated cases, where the exudation is 
abundant, or in cases developed in cachectic constitutions, with 
a pysemic tendency, we shall have to compare: Arsen., Calc. carb., 
Camphora., Carb. veg., China, Ferrum, Hepar, Iodium, Kreosot, 
Laches., Lycop., Sepia, Senega, Silic, and others. 

Paracentesis has seldom proved beneficial in acute cases ; in 
chronic cases it may in rare instances be the indicatio vitalis, 
when the rapidly increasing purulent exudation threatens suffo- 
cation. The emptying ought to be effected by aspiration, in 
order to prevent the entrance of air into the pleural cavity. If, 
after several tappings, the purulent exudation persistently and 
profusely returns, the old school of late years opens the pleural 
cavity and washes it out with warm distilled water until every 
trace of purulent matter has disappeared, when injections of 
iodine, or carbolic acid, or other similar substances are made, 
until by granulation the pleural folds have healed together. 



424 



AFFECTIONS OF THE PLEURA. 



" Radical cure," as it is termed. Compare Frsentzel on pleuritis, 
in Ziemssen's Cyclopaedia, Vol. IV. 



Pneumothorax. 

This consists of a collection of air or gas within the pleural sac. 
As air alone, however, is rarely found in this locality, but mostly 
in combination with pus, blood, or serum, it is called, according to 
the nature of the coexisting fluid, either pyo-, or hsemato-, or 
hydro-pneumothorax ; when an exudation of pus or blood follows a 
collection of gas in the pleural cavity, it is termed pneumo-, pyo-, 
or pneurno-hsematothorax. 

Pneumothorax, whether it be in combination with fluids or 
not, is always characterized by an enormous extension of the 
thoracic wall of the affected side, the intercostal spaces of which 
bulge out. When on the left side', it pushes the heart towards 
the right; if on the right, it presses the liver down into the 
abdominal cavity. The lung itself is compressed to a small 
volume, containing little or no air, and lying close to the spine. 




Pneumothorax on Right Side. (After Bock.) Pneumothorax on Left Side. (After Boek.) 



a. Heart displaced. 

b. Liver displaced. 

c. Stomach. 

d. Distention by gas. 

e. Compressed lung and tubercul 



a. Heart displaced. 

b. Kightlung. 

c. Compressed lung and tuberculous i 

d. Distention by gas. 

e. Stomach. 
/. Liver. 

g. Spleen displaced. 



The gas, which is collected within the pleural sac, consists 
mostly of carbonic acid gas and nitrogen, with very little oxy- 
gen; and in cases where decomposition has taken place, of sul- 
phuretted hydrogen. These gaseous substances may be diffused, 
and fill the whole pleural cavity of one side, or they may, in rare 



PNEUMOTHORAX. 425 

cases, be limited therein to a certain portion, in consequence of 
previous pleuritic adhesions. 

The entrance of air into this cavity almost always causes, in a 
short time, a pleuritis with either sero-fibrinous or purulent exuda- 
tion; and is occasioned either by a perforation of the pleura pulmo- 
num, in consequence of lung diseases, especially pulmonary con- 
sumption and empyema, in which case the air enters from the 
air-cells of the lungs; or by a perforation of the thoracic wall, by 
traumatic causes, when the air enters from without; that gaseous 
substances may be formed by means of decomposition in a pyothorax 
has of late been greatly doubted. 

In cases in which the air fills the pleural sac through the lungs, 
it takes place almost always quite suddenly, and the patient has 
a feeling as though something had bursted in the chest, which in 
fact is the case. At the same time he experiences great difficulty 
in breathing; he is obliged to sit erect, and can lie only on the 
diseased side, and for an obvious reason — to keep the sound lung 
free from any pressure. The worst cases are those which exist in 
consequence of tuberculosis, gangrene, or carcinomatous degenera- 
tions of the lungs. Those in consequence of emphysema or 
external perforations are not so violent. 

Inspection. Enormous enlargement of the diseased side of the 
thorax; its intercostal spaces bulge out; perfect want of respira- 
tory motion. 

Palpation. Total absence of vocal fremitus; liver or spleen 
displaced downwards; heart towards the middle or the right side 
of the thorax. 

Percussion. Tympanitic sound, unless greatly distended, when 
it becomes non-tympanitic, or full lung sound. Dull sound in the 
upper posterior region, where the compressed lung lies, and in 
the lower regions of the thorax, when effusion exists, changing 
locality with the patient's change of position. 

Auscultation. Absence of respiratory murmur by full resonant 
percussion sound; metallic tinkling when the patient talks, coughs, 
or inhales deeply. Bronchial breathing and bronchophony, 
where the compressed lung lies. 

In cases where air and fluids co-exist we hear a splashing 
sound whenever the patient moves quickly, just like water in a 
half-filled bottle, if it be shaken. 

Likewise do we sometimes hear a falling of drops with a 
metallic tinkling sound, when the patient rises from a recumbent 
position. 



426 AFFECTIONS OF THE PLEURA. 

Differential Diagnosis. — Pneumothorax differs from emphy- 
sema by its dyspnoea coming on suddenly and growing worse 
steadily ; by its one-sided distention of the thorax, the intercostal 
spaces of which bulge out; by its want of vocal fremitus, the 
absence of the vesicular murmur, and the presence of the metallic 
tinkling sound. 

It differs from large superficial cavities, by the distention of the 
thorax and the displacement of heart, liver or spleen, and the 
absence of vocal fremitus. 

THERAPEUTIC HINTS.— For the sudden dyspnoea, Arsen. 

When caused by external injury, Aeon., Arnica, Staphys., and 
others. 

AVhen in connection with consumption, compare the remedies 
mentioned there. 

For the subsequent inflammation of the pleura, compare Pleu- 
ritis and Pneumonia. 



Hydrothorax, Dropsy of the Chest. 

This is a collection of serum in the pleural sac, without any 
inflammatory process in that locality. It is mostly found on both 
sides of the chest at the same time, although one side may con- 
tain more fluid than the other. The serum is clear, yellowish or 
greenish; sometimes reddish, when mixed with blood; it never 
contains fibrinous substances, as an exudation of pleuris}' always 
does, but in place of it a great deal of albumen. The pleura itself 
looks pale and dull, without any sign of inflammation; the lung 
is pressed towards the spine whenever a large amount of such 
fluid exists, and generally appears cedematous. 

Hydrothorax originates mostly in consequence of lung and 
heart diseases, which cause obstruction to the venous circulation 
within the lungs; or in consequence of such morbid states of the 
body as cause the blood to become thin and watery, as is the case 
in Bright's disease, in certain spleen and liver affections, in anae- 
mia, in intermittent cachexia. It is, therefore, almost always 
attended by other dropsical conditions. 

From this it is apparent that its symptoms must vary greatly. 
Its most prominent feature, however, is dyspnea, which is always 
worse in a lying, and better in a sitting position, and this for obvious 
reasons : when sitting the fluid settles to the lower part of the 



HYDROTHORAX, DROPSY OF THE CHEST. 427 

thoracic cavity and leaves the upper part of the lungs free for 
respiratory action; whilst in a horizontal position the whole lung 
becomes overflown and compressed by the fluid. Where there is 
a great deal of serous effusion the patient seems to suffocate whenever 
he turns in lied. Niemeyer explains this important sign in the 
following manner : as the fluid is not limited to a certain place, 
as is the case of pleuritic effusions, it changes its position freely 
whenever the patient changes his position, following the law of 
gravitation. Wherever it locates, there it naturally compresses 
the lungs, makes them unfit for respiration, whilst the uncom- 
pressed portion fulfils this office undisturbed. A turn of the 
body reverses at once the location of the fluid ; it now compresses 
those portions of the lungs which were breathing, and sets others 
free that were compressed. Ere these can be pervaded by air, 
the patient has no breath. This explains fully those suffocating 
fits which such patients experience when turning in bed. 

Inspection. Enlargement of the thorax. 

Palpation. Absence of vocal fremitus and displacement of 
heart, liver, spleen. 

Percussion. Dull sound as far as the fluid reaches, changing 
locality in different positions of the patient. 

Auscultation. Absence of vesicular breathing where the fluid 
covers the lungs, but bronchial breathing about the spine, where 
the lungs are compressed. 

THERAPEUTIC HINTS.— Apis, great oppression; inability to lie 
down; absence of thirst; urine dark, like coffee; after taking cold, 
during desquamation in scarlet fever. 

Apoc. cann., inability to speak; catching of the breath; irrita- 
bility of stomach so great that even a draught of cold water is 
rejected ; suppression of urine. 

Asclep. syr., recommended especially after scarlet fever. 

Arsen., dyspnoea, worse from any exertion; when lying down 
at night, if ever so carefully, the patient experiences a sense of 
suffocation; also when turning in bed; with great anxiety; pal- 
pitation of the heart and great dryness; drinking constantly but 
little at a time. 

Aspar., old people with heart diseases. 

Bryon., pain in the side; cough, with contraction of the dia- 
phragm ; vomiting and splitting pain in the head, excited by any 
motion ; retarded stool and frequent desire to pass water, but only 
a few drops flow. 



428 AFFECTIONS OF THE PLEURA. 

Colonic, asthma; oedematous swelling of hands and feet; con- 
stant urging to pass water, as from spasm of the bladder, but 
only little is voided, and that with great pain; heart disease in 
consequence of acute rheumatism. 

Digit, intermitting pulse ; paleface; cold skin; flabby, oedema- 
tous swelling all over; difficult urination; cyanotic symptoms, 
with fainting. 

Helleb., slow comprehension ; slow in answering questions ; pale 
face; griping pain in the bowels, with diarrhoea of a jelly-like 
slime. 

Kali carb., whizzing breathing; oppression worse about three 
o'clock in the morning; oedematous swelling between the eye- 
brows and lids, looking like a little bag; insufficiency of the 
mitral valves; great dryness of the skin. 

Laches., suffocating fits, waking from sleep, with throwing the 
arms about; cyanotic symptoms; swelling of the liver; black 
urine ; offensive smell of feces. 

Lycop., dyspnoea worse when lying on the back ; constipation ; 
rumbling in the left iliac region ; red urine ; exceedingly cross 
after getting awake. 

Mercur., after scarlatina ; oedematous swelling all over ; sweat- 
ing without improvement; dry, hard cough; inflammation of 
the genital organs. 

Squilla, strong urging to urinate, with scanty and dark urine; 
continuous cough, with mucous expectoration; oedematous swell- 
ing of the body. 

Senega, loose, faint, hacking cough, with expectoration of a little 
phlegm. 

Spigel., dyspnoea during motion in bed; can lie only on the 
right side and with the trunk raised; danger of suffocation when 
making the least motion or raising the arms, with anxiety and 
palpitation of the heart. 

Sulphur, sudden arrest of breathing at night in bed when turn- 
ing to the other side; going off when sitting; constipation, or 
diarrhoea in the morning; liver complaint; red lips. 

Tart, emet, much coarse rattling in the chest; expectoration 
not equivalent to the secretion within; drowsiness; cyanotic 
symptoms. 



HvEMATOTHORAX. 429 



Hsematothorax 



Is an effusion and accumulation of blood within the pleural 
cavity without inflammatory symptoms, brought on either by 
external injuries of the chest, from stabbing, gunshot wounds, 
fracture of the ribs, contusions, or from internal ruptures of 
blood-vessels, carcinoma and tubercles. 

The patient complains of sudden dyspnoea, with or without 
cough; his face grows pale; he faints, has ringing in the ears; 
darkness comes before his eyes, and the skin is cold. 

the same as in Hydrothorax. % 



THERAPEUTIC HINTS.— When from external causes, compare 
Aeon., Arnica, Calend., Eriger., Hamam., Rhus tox. and the like. 
When from internal causes, they must be considered in each in- 
dividual case, and reference should be taken to those remedies 
which are indicated in haemorrhages from the lungs. Great loss 
of blood indicates China, and a nourishing diet. 

For the subsequent pleuritus, compare the corresponding 
chapter. 



THE HEART 



Auscultation. 

First step: To know how the heart works. 

The heart consists of four apartments: two antechambers 
(auricles) and two chambers (or ventricles), which are respec- 
tively named from their position, right and left. 

Into the right auricle the venae cavse empty all the blood which 
has been used in the body for its sustenance. From this ante- 
chamber a large aperture leads into the right ventricle, which is 
called the auriculo-ventricular opening, and which is guarded by a 
kind of gate, consisting of three triangular folds (the tricuspid 
valves), opening inward. In the right ventricle we observe 
another opening, which leads into an arteiy called the pulmonary 
artery, because it brings the deoxygenized blood into the lungs. 
This opening is likewise guarded by a set of valves, which, from 
their half-moon shape, are called semi-lunar valves, and which 
open outward. 

This arrangement we find repeated in the left auricle and ven- 
tricle. Into the left auricle the pulmonary veins empty all the 
blood which has been oxygenized in the lungs. From this cav- 
ity a like aperture leads into the left ventricle, which is likewise 
guarded by valves, consisting, however, of only two segments [the 
bicuspid or mitral valves), opening inward. 

In the left ventricle we observe also an opening, which leads 
into an artery called the aorta, and which distributes the blood 
all over the body. This opening is likewise guarded by a set of 
valves of semi-lunar variety, which open outward. 

Now let us see how this apparatus works. The ventricles being 
fully distended, they immediately and simultaneously begin to 
contract. On account of the relation of the several valves to 



AUSCULTATION. 



431 



these two cavities, the action of the blood under the great press- 
ure from this contraction forcibly shuts the tricuspid and mitral 
valves, thus closing the auriculo-ventricular openings, and the 
same action opens both sets of semi-lunar valves for the escape 
of the blood. Through the pulmonary artery the dark blood is 
propelled to the lungs, whenqe it is returned through the pul- 
monary veins to the left auricle, thus making the lesser circuit — 
the pulmonic circulation. Through the aortic valves and artery 
the red blood is propelled through the whole body, whence it is 
returned through the venae cavse to the right auricle, thus mak- 
ing the greater circuit — the systemic circulation. As the two ven- 
tricles contract, the two auricles dilate, and vice versa. The con- 
traction of the ventricles and simultaneous dilatation of the 
auricles is called the heart's systole, and by causing a forcible 
closure of the auriculo-ventricular valves produce the first sound 
of the heart. The dilatation of the ventricles and simultaneous 
contractions of the auricles is called the heart's diastole, and by 
forcibly closing the two sets of semi-lunar valves produce the 
second sound of the heart. This explanation of the two sounds of 
the heart suffices for my purpose, and may be demonstrated to 
the eye by the following diagram : 




This first step we must make securely, if we want to get along 
at all towards reaching the goal of diagnosticating heart diseases : 
the first sound is caused by the shutting of the tricuspid and mitral 
valves. The second sound is the consequence of the shutting of the 
semi-lunar valves. 



432 HEART. 

Second step : How to find the exact situation of these different valves 
in the living subject. 

In order to find out the position of the heart, and its parts, we 
must first ascertain where it strikes against the thoracic wall. 

It does it with its apex, and in a majority of cases between the 
fifth and sixth ribs, about one inch on the right of a line drawn 
vertically through the left nipple, the person being in an upright 
position. In persons of a short stature, we find the heart's im- 
pulse between the fourth and fifth ribs; and in persons with a 
long thorax, it may be felt still lower. So also different positions 
of the body change the place of impulse. In a person lying upon 
the back, it is observed nearer to the medium line; while lying 
upon the left side causes it to tilt over more towards the nipple 
line. This point of impulse we must take as a fixed point for 
determining the position of the left ventricle, which it never fails 
to represent. The other parts have a constant relation to this. 

The base of the heart, and consequently the aortic and pul- 
monary valves, are almost invariably situated behind the middle of 
the sternum. 




The ascending aorta lies somewhat to the right of the vertebral 
column, and consequently its sounds and murmurs must always 
be sought for over the middle and somewhat to the right of the 
sternum. 



AUSCULTATION. 433 

The mitral valves are situated nearly one inch below those of 
the aorta, and on the left side of the sternum. 

The tricuspid valves are to the right of and anterior to the mitral, 
and they are for the most part covered by the sternum. 

The position of the right ventricle is variable, and cannot be 
determined, unless that of the left ventricle and aorta has been 
previously ascertained; it lies mostly under the lower part of the 
sternum. 

The valves of the pulmonary artery are situated under the 
cartilage of the third rib to the left of the sternum. 

The diagram opposite shows the exact position of these parts. 

Now, if we remember all this, we shall hear those sounds which 
originate in the left ventricle, in the mitral valves, most distinctly at 
that part of the thorax against which the apex of the heart strikes ; 
those sounds which originate in the ascending aorta we shall hear best 
a little to the right of the centre of the sternum, and from thence up- 
wards; those sounds which originate in the pulmonary artery we shall 
hear best a little to the left of the centre of the sternum ; those sounds 
which originate in the tricuspid valves we shall hear loudest over the 
central and lower part of the sternum. 

If we now consider that diseases of the pulmonary valves and 
the tricuspid valves are of very rare occurrence, we may centre 
our attention upon only these two points : 

1. Upon the sounds of the mitral valves; heard best at that part 
of the thorax against which the apex of the heart strikes ; and, 

2. Upon the sounds of the aortic valves; heard best a little to 
the right of the centre of the sternum, and thence upwards. * 

Third step : Of the different morbid sounds and murmurs of the heart. 

1. The left chamber during its systole. 

The first sound, heard clearest at the apex, is proof, 

1. That the mitral valves shut perfectly ; not allowing any blood 
to regurgitate into the auricle ; and, 

2. That the aortic valves and orifice offer no obstacle to the direct 
passage of the blood out of the left ventricle. 

But, suppose the mitral valves be deficient, so that they would not 
shut perfectly during the rush of blood against them, what would 
be the consequence of this deficiency? Simply, the stream of 
blood would not be stopped there, but would re-enter the auricle 
and thus cause a noise, but no tic. 

Or, suppose the aortic valves be stiffened or roughened, or the 
aortic opening constricted, so that the stream of blood in its 

28 



434 HEART. 

course onward would be interfered with, what would be the con- 
sequence of such obstruction ? The stream of blood would rub 
against the obstacle and cause a noise or murmur at the same 
time when the closure of the mitral valves would give the first tic. 

Or, suppose the mitral valves be deficient, and, at the same time, 
the aortic valves stiffened and roughened, or the aortal opening 
constricted, what would be the consequence of this deficiency and 
obstruction? Well, the stream of blood would regurgitate through 
the auriculo-ventricular opening, and also rub against the obsta- 
cles in the aortic opening, and thus cause a noise but no tic. 

How then can we distinguish between these three different af- 
fections ? In case of insufficiency of the mitral valves, the blood re- 
gurgitates at each contraction of the heart into the left auricle ; 
and thus it becomes retarded in the whole lesser circuit. In con- 
sequence of which the right ventricle must make stronger efforts 
to drive it onward, and the pulmonary artery, becoming largely 
distended^ contracts the more, thus causing a more violent shock 
backwards against its semilunar valves, and consequently a louder 
diastolic sound of the pulmonary artery. An increase of the second 
or diastolic sound of the pulmonary artery is, therefore, almost 
invariably attending an insufficiency of tbe mitral valves. We 
must, then, when we hear a noise instead of the systolic sound 
at the heart's apex, make sure whether there is also an increased 
second sound of the pulmonary artery. The valves of this artery 
are situated under the cartilage of the third rib to the left of the 
sternum — there we put the stethoscope, and if it turns out so, we 
may be sure that the noise which we hear at the apex, instead of 
the systolic sound, is caused by an insufficiency of the mitral 
valves. 

In case of constriction of the aortic opening we hear the systolic 
sound and a noise betides. If we put our ear over the aorta, 
towards the right of the centre of the sternum, we hear the noise 
there even plainer than at the apex. 

In case of insufficiency of the mitral valves and constriction of the 
aortic orifice combined, we shall find these features united: an 
increased second sound of the pulmonary artery, and a noise 
over the aorta. 

2. The left ventricle during its diastole. 

The diastolic or second sound of the heart, is proof — 1, That the 
aortic valves shut well, not allowing any blood to regurgitate 
into the left ventricle; and 2, That the mitral valves or the 



AUSCULTATION. 435 

auriculo-ventricular opening offer no obstacle to the passage of 
blood out of the left auricle into the left ventricle. 

But, suppose the aortic valves be insufficient, so that they would 
not close tightly after the blood had been driven through them ; 
what would be the consequence of this insufficiency? The con- 
traction of the aorta would drive some of the blood back again 
into the left ventricle, and thus cause a noise or murmur instead 
of the second sound. 

Or, suppose the mitral valves be stiffened, roughened, or the 
auriculo-vcntricular opening constricted, so that the passage of the 
blood into the ventricle were interfered with, what would be the 
consequence of such obstruction? The stream of blood would rub 
against the existing obstacle and cause a noise or murmur during 
the diastole of the ventricle at the same time when the closure of 
the aortic valves would give the diastolic sound. 

Or, suppose the aortic valves be insufficient, and, at the same 
time, the mitral valves or auricido-ventricular opening obstructed, 
what would be the consequence of this insufficiency and obstruc- 
tion? Surely the stream of blood would regurgitate through the 
aortic valves into the left ventricle, and also rub against the 
obstacles in the mitral valves and auriculo-ventricular opening, 
and thus cause a noise or murmur, but no diastolic sound. 

And how can we distinguish between these different affections? 
In case of insufficiency of the aortic valves, we shall hear a noise or 
murmur instead of the second sound most distinctly over the 
aorta to the right of the centre of the sternum. 

In case of thickening of the mitral valves, or constriction of the 
auriculo-ventricular opening, the blood accumulates in the lesser 
circuit, produces hypertrophy, with dilatation of the right ven- 
tricle, and an increased diastolic sound of the pulmonary artery 
much more readily than mere deficiency of the mitral valves. 
The more constricted the mitral orifice is, the longer will be the 
time necessary for the flow of the blood into the ventricle, and 
the more prolonged and louder the murmur. In cases of this 
kind the vibrations may even be felt and seen. 

In case of insufficiency of the aortic valves and constriction of 
the mitral orifice combined, we shall, of course, find both features 
united — a noise instead of the second sound over the aorta and a 
murmur over the mitral valve, with an increase of the diastolic 
sound of the pulmonary artery. 

3. The left ventricle during its systole and diastole. 



436 HEART. 

The clear systolic sound indicates that the mitral valves close 
perfectly, and that the aortic opening is not constricted. The 
clear diastolic sound indicates that the aortic valves shut well, 
and that the mitral orifice is not constricted. But suppose the 
mitral valves be insufficient, and, at the same time, the auriculo-vcn- 
tricular opening constricted, what would be the consequence of 
such insufficiency and constriction at the same time ? The systole 
would cause a regurgitation of the blood into the auricle, and 
the diastole a friction of the blood during its passage through the 
constricted mitral opening, and thus we would hear a see-saw, a 
noise instead of the first, and a noise accompanying the second 
sound. 

Or, suppose the aortic rains be insufficient, and, at the same time, 
the aortic orifice constricted, what will be the consequence of such 
a state ? 

Undoubtedly the contraction of the heart would cause a noise 
by driving the blood through the constricted orifice, and during 
the dilatation of the heart the blood would regurgitate and cause 
a murmur instead of the second sound. 

And how are we to distinguish between these two different 
affections? 

When the mitral valves are insufficient, and the auriculo-ven- 
tricular opening is at the same time constricted, Ave must find 
also an increased second sound of the pulmonary artery. "When, 
however, insufficiency of the aortic valves and constriction exist 
in the aortic opening, we hear the murmur most distinctly over 
the aorta. 

A comparison of the diagram on circulation, page 431, will 
help much in elucidating these complicated states. 

All that I have said here of the left ventricle and its valves 
during its systole and diastole is almost verbally applicable to 
the right ventricle and its valves. As, however, valvular dis- 
eases on the right side of the heart are exceedingly rare com- 
pared with those of the left side, and even when present on the 
right side, they almost always exist to a greater extent upon the 
left than upon the right side. (H. M. Hughes.) I think it best 
to break off here, so that I may not bring confusion upon, instead 
of elucidation to, this subject: and I shall at once proceed to 
speak of those morbid sounds, resembling murmurs, but which 
have nothing to do with the valves of the heart. 

1. Anaemic murmurs. '"They are ordinarily of the softer kind, 



AUSCULTATION. 437 

and resemble the blowing of a pair of bellows, but are sometimes 
harsh and resemble tbe rougher morbid sounds, as that of filing 
or sawing." (H. M. Hughes.) They are generally confined to the 
situation of the aortic or pulmonary valves, or both. They do 
not follow the course of the large vessels so fully or frequently as 
do the murmurs arising from disease of the valves. They occur 
only during the systole of the ventricles; they are not generally 
heard below the left nipple, because they do not originate in the 
mitral opening. They are almost always accompanied with a 
smart, smacking impulse. They generally disappear for a time, 
while the individual is quiet mentally as well as bodily, if by 
that quiet the heart assume a natural impulse; and they are al- 
ways diminisbed and generally disappear entirely under suitable 
treatment. (H. M. Hughes.) 

The origin of these anaemic murmurs have been attributed: 1, 
to a watery condition, or a diminution of ordinary viscidity of 
the blood, in consequence of which the particles of the fluid are 
more easily agitated and thus give rise to the vibrations which 
produce the murmur; 2, to the remarkably quick and sudden 
contraction of the ventricles, in consequence of which the fluid 
contents of the cavities are propelled quicker through the arterial 
openings than in health, and thus give rise to greater friction, 
which produces the murmur, although no actual constriction ex- 
ists there. (H. M. Hughes.) 

2. Venous murmurs (nun's murmur, top-murmur) are heard in 
many young persons in the anterior triangular space in which 
the external jugular vein descends. It is a continuous murmur, 
and is generally more audible on the right than on the left side. 
This murmur disappears when the current of blood is interrupted 
by pressure upon the jugular vein, by a deep expiration, or by 
any position of the body in which the head lies lower than the 
thorax. 

It is heard loudest in an erect position and during inspiration. 

It is thought to be in connection with anaemia, but Skoda says 

that he has found it also in young and quite healthy individuals. 

3. Pericardia] murmurs. As long as the inner surface of the 
pericardium is in its natural condition, slippery and glistening, 
the heart moves within it without any sound; just as the two 
blades of the pleura glide over each other inaudibly, as long as 
they are in a natural condition. Not so, however, when this slip- 
pery and glistening surface becomes roughened in consequence 



438 DISEASES OF THE PERICARDIUM. 

of inflammation and subsequent fibrinous exudation. Then we 
bear at once a friction sound, which, according to Skoda, may 
resemble perfectly an endocardial mur,mur. 

How are we then to distinguish between a friction sound caused 
in the pericardium, and a sound caused within the heart? 

Skoda says : " I know no sign by which the friction sounds of 
the pericardium can be distinguished from the internal murmurs 
of the heart, excepting this — that the internal murmurs corre- 
spond pretty exactly to the rhythm and to the natural sounds 
of the heart; whilst the pericardial friction sounds seem to follow 
upon the movements of the heart. This distinctive sign is only 
available when the murmur is somewhat prolonged ; if it be of 
short duration, we cannot determine whether it is endocardial or 
pericardial." Skoda, p. 253. 

To this difficulty still another may be added, viz. : the friction 
sound may also arise from a roughened condition of that portion 
of the pleura which covers the unattached parts of the pericar- 
dium. The sound is produced by the rubbing of the pleura 
which covers the free portion of the pericardium, either against 
the thoracic walls or against the surface of the lungs. Being- 
caused by the action of the heart, it coincides with its movements 
as completely as though it had been produced within the peri- 
cardium. The murmur thus arising external to the pericardium 
exactly resembles the murmur arising within it, and here we 
have no means of distinguishing. 

The special diseases of the heart I shall arrange under the fol- 
lowing heads : 

1. Diseases of the pericardium. 2. Diseases of the endocardium 
and its valves. 3. Diseases of the heart-muscle itself. 4. Ner- 
vous diseases of the heart. 



I. DISEASES OF THE PERICARDIUM. 

Pericarditis, Inflammation of the Pericardium. 

The internal layer of the pericardium being a serous mem- 
brane, like the pleura, its inflammation presents precisely the 
same anatomical character as that of pleurisy. We find' injec- 
tion, swelling, and exudation of either a serous or sero-fibrinous. 
or to the most part fibrinous fluid. In this latter case the fibrin 
is precipitated upon the walls of the pericardium, and forms net- 



PERICARDITIS. 439 

work-like, villous masses, which have given rise to the name of 
cur villosum or hirsutum, most frequently found in pericarditis 
complicated with articular rheumatism. During the process of 
inflammation, sometimes the injected capillaries hurst, and thus 
cause a hloody exudation. 

When pus globules form in great abundance, the exudation be- 
comes purulent, and, if it undergoes decomposition, it becomes a 
fetid, discolored, ichorous fluid, as in empyema. 

In some cases the inflammation does not result in exudation 
of any kind — pericarditis sicca, — in consequence of which, adhe- 
sions form without any noticeable symptoms. 

The mere serous exudation is most thoroughly absorbed again, 
while the fibrinous fluid gives rise to adhesions between the heart 
and the pericardium. 

A large quantity of this fluid hinders the heart in its move- 
ments and pushes it back from the thoracic walls ; at the same 
time it may compress part of the lung and the large vessels. 

It causes also congestion of the lungs, the brain, and the liver, 
serous exudation into the lower lobes of the lungs, the pleura, 
and the membranes of the brain and oedema of the lower ex- 
tremities. 

Pericarditis may set in primarily in consequence of external 
injuries or taking cold ; such, however, is very rarely the case ; 
or, secondarily, during the progress of acute rheumatism, which 
is its most frequent occasion. But it may result also from pleu- 
risy, pneumonia, or ulcerative processes of the ribs, vertebrae, 
oesophagus, stomach, liver, etc. ; or it may accompany morbus 
Brightii, tuberculosis, diseases of the valves, cancer, intermittent 
fevers, etc. It occurs, too, in typhus, variola, pyaemia, puerperal 
and exanthematic fevers. 

Chronic forms of pericarditis are caused by long-continued 
mental depressions, abuse of spirituous liquors, violent exertion 
of the body, and chronic, gouty affections. 

Its Symptoms, if it is a primary affection, or in combination 
with acute rheumatism, are — 

1. More or less violent fever, sometimes commencing with 
chills, followed by heat, great acceleration of pulse, and palpita- 
tion of the heart. 

2. As in pleurisj 7 , we must consider the stitch or sharp cutting 
pain in the region of the heart as a characteristic, subjective sign, 
which is increased by motion, deep inspiration and external 
pressure. 



440 DISEASES OF THE PERICARDIUM. 

3. Dyspnoea is present in almost all cases ; sometimes to such 
a degree that the patient is incapable of lying down at all. 

4. Cough is sometimes wanting, but in most cases we find a 
short, dry, hacking cough. 

5. The position of those patients who can lie down is on their 
left side or on their back. 

Pericarditis in complication with pleurisy or pneumonia may 
in some cases not be diagnosticable during its development, even 
by the most careful physical examination. In complication with 
tuberculosis, Bright's disease and chronic heart diseases only 
careful physical examination will lead to its detection, which is 
also true if pericarditis sets in during the course of grave blood- 
diseases, such as scarlatina, puerperal fever, etc. 




rditic Exudatios. (After Bock.) 



a. Pericardial Sac filled with fluid, h. Diaphragm, c. Right lung. d. Compressed left lung. 
e. Liver. /. Stomach. 

Auscultation reveals the heart sounds very weak, sometimes 
scarcely audible. This weak impulse of the heart's action is 
characteristic if we find at the same time on percussion the dull 
heart sound cover a larger space than normal. But the first 
physical sign which appears, (although seldom during the first 
two or three days of the disease) is the friction sound, produced by 
the deposition of fibrinous masses upon the smooth pericardial 
folds. The now roughened surfaces give this friction sound dur- 
ing their continual gliding over each other in consequence of the 
motion of the heart. It is frequently heard first and loudest over 
the base of the heart, but may also be heard first and loudest 
over any other part of the heart ; it does not only accompany the 
heart sounds, but is prolonged beyond them, is interposed, as it 
were, between them (Skoda), and may occupy the whole duration 
of the cardiac movement. When the exudation increases largely, 



PERICARDITIS. 441 

it grows weaker, and may disappear altogether, but on the de- 
crease of the fluid, it reappears again. It may also be made audi- 
ble again in some of such cases, by changing the position of the 
fluid by causing the patient to sit upright, or to bend his body 
forwards. 

Inspection shows in young persons a swelling or bulging out of 
the precordial region in advanced cases, with a large quantity of 
exudation. In older persons, where the cartilages of the ribs 
have become ossified, such enlargements cannot take place. 

Palpation discovers in the beginning of the disease a stronger 
impulse of the heart at its normal place; but later this impulse 
becomes weaker and finally ceases altogether, when the collection 
of fluid pushes the heart back from off the thoracic walls. 

When there is a loud friction sound, this becomes noticeable 
also to the sense of touch, and feels like the purring of a cat. 

Percussion at first reveals nothing. There must be already a 
considerable quantity of fluid exudation before we perceive the 
natural dull percussion sound of the heart spread over a larger 
circumference ; and if the lung happens to be in a position that 
it covers the filled pericardium, we cannot get a dull sound in 
spite of even a very large quantity of fluid. 

At first the exudation is confined to the base of the heart and 
the origin of the arteries. Here then we have at first to look for 
an increase of dulness of the percussion sound. Later, the dull 
percussion sound may increase in the long diameter, down the 
heart ; and if the effusion is very considerable, also in its trans- 
verse diameter, so that if, according to Skoda, the pericardium 
contains as much as two pounds of fluid, the percussion sound 
becomes completely dull from the second left costal cartilage to 
the lower border of the thorax, and from the right edge of the 
sternum to the middle of the left lateral region. 

Secondary pericarditis of course develops itself differently. It 
being a mere additional symptom or consequence of, or compli- 
cation with, some other disease, its first onset is hidden by the 
symptoms of that disease. But, when once developed, its pres- 
ence must of necessity be indicated by the same physical signs 
which I have detailed above. 

Uncomplicated pericarditis is, of course, much more easily 
cured than when complicated. In the latter case our prognosis 
has to be based altogether upon the nature of that complaint with 
which it is combined. 



442 DISEASES OF THE PERICARDIUM. 

THERAPEUTIC HINTS.— Aeon., chill at the commencement, fol- 
lowed by fever-heat; stitching pain in the region of the heart; 
impossibility to lie on the right side; great restlessness; frequent 
sighing and taking a deep breath; feeling of fulness in the chest, 
dyspnoea; fainting. 

Arsen., in consequence of repelled measle- or scarlet-fever-rash; 
inexpressible anguish and restlessness; worse at night; the 
patient finds no ease in any position; flushed face; paralytic 
feeling in the upper extremities; tingling in the fingers; cold 
perspiration. 

Bryon., stitching pain in the region of the heart, preventing 
motion and even breathing ; wants to lie perfectly quiet. 

Caet. grand., sensation of constriction in the heart, as if an iron 
hand prevented its normal movement; acute pains and stitches 
in the heart; difficulty of breathing; attacks of suffocation, with 
fainting; cold perspiration in the'face, and loss of pulse; palpi- 
tation when walking, and at night when lying on the left side. 

Digit, copious serous exudation, rheumatism ; irregular, in- 
termitting pulse ; brick-dust sediment in the urine. 

Iodium, in complication with croupous pneumonia; purring 
feeling in the region of the heart ; violent palpitation, increased 
from the slightest motion, better while lying perfectly quiet on 
the back ; fainting spells. 

Kali cart)., stitching pain in the region of the heart ; swelling 
between the eyebrows and the upper lids, like little bags ; jerking 
up of the limbs, much frightened when having the feet touched ; 
everything worse about three o'clock in the morning. 

Laches., restless and trembling; hasty talking; great oppression ; 
anguish about the heart in rheumatism; irregularity in the beats 
of the heart. 

Psorin., psoric nature ; better while lying quietly. 

Pulsat, the patient weeps easily, is thirstless, often changes 
position, has a loose, rattling cough, worse on first going to bed ; 
rheumatic pains, which quickly change locality; inclination to 
looseness of the bowels ; suppressed menstruation. 

Rumex, during rheumatism; burning, stinging pain in the left 
side of the chest near the heart when taking a deep inspiration, 
when lying down in bed at night. 

Spigel., when, notwithstanding the use of Aconite, the fever 
continues and the rubbing soUnd commences; stitching pain in 
the chest from the very slightest motion. 



HYDROPERICARDIUM. 443 

Sulphur, palpitation after going up stairs, with shortness of 
breath; steady pain in the left side through to the shoulders; 
red lips ; sleeplessness ; after suppressed itch. 

Tart, emet, in complication with pleuro-pneumonia. 

Ver. vir., faintness after rising from a recumbent position ; syn- 
cope when walking; relieved only by lying down. 

Existing complications will no doubt hint to many other 
remedies. 

Hydropericardium, Dropsy of the Pericardium. 

The pathological character of this disease consists of a collec- 
tion of serum without fibrin. A fibrinous exudation never takes 
place without an inflammatory process. The serum is a yellowish, 
clear fluid; sometimes, if mixed with blood, it is brownish or 
reddish, and always of alkaline reaction. In renal diseases it 
contains some urea, and in general icterus the coloring matter 
and acids of the bile. A small quantity of such fluid is found in 
most post-mortem examinations. To constitute dropsy of the 
pericardium, this sac must contain at least several ounces of 
serum, and it amounts in some cases even to over one pound. 
When such is the case, the pericardium is distended, is of a dull 
whitish color, without lustre; the fat upon the heart js gone, and 
the cellular tissue appears oedematous; the lung becomes com- 
pressed and the thorax enlarged. 

Dropsy of the pericardium is generally the consequence of a 
hydrsemic condition of the blood, or of diseases which cause 
dropsical affections in other parts also, such as chronic affections 
of the spleen, morbus Brightii, cancer, anaemia, dilatation of the 
right ventricle, etc. It is also found in consequence of conditions 
which prevent the necessary oxygenation and free circulation of 
the blood, as in emphysema, in cirrhosed lungs, in defects of the 
valves of the heart. 

Hydropericardium is, therefore, altogether a disease of second- 
ary nature, and its symptoms do not become very prominent, 
unless a very considerable quantity of fluid collects within the 
pericardium. Then we observe great dyspncca, which prevents 
the patients from lying down ; any effort to do so at once causes 
an attack of suffocation; they have to sit up clay and night with 
their bodies bent forwards. The jugular veins swell and dropsical 
affections appear also on other parts of the body; first in the 



444 DISEASES OF THE ENDOCARDIUM. 

lower extremities; then in the genitals; later, within the perito- 
neum and the pleurae; finally, the dropsical swelling invades the 
whole body, and the impeded respiration and circulation cause 
stupor and death. 

The physical signs are: no friction sound; distention of the 
precordial region in young subjects; impulse of the heart either 
absent or weak; weak sounds of the heart; and dull percussion 
sound in a wider circumference than the heart alone would give 
rise to. 

THERAPEUTIC HINTS.— Compare Hydrothorax. The leading 
features will have to be taken from the fundamental disease. 



II. DISEASES OF THE ENDOCARDIUM. 
Endocarditis. 

Inflammations of the endocardium end either in ulcers, in 
thickenings of the membrane, or in villous formations of the 
connective tissue, which in course of time undergo further 
changes. 

1. The Acute ulcerative or Diphtheritic form is usually found in 
the left side of the heart, most frequently affecting the mitral and 
aortic valves, although the walls of the auricles and ventricles 
are not exempted. At first the lining membrane appears only 
dirty gray, opaque and dull, but soon shows proliferations in the 
connective tissue, and a deposition of fibrinous masses, which, 
after softening and crumbling away, leave ulcers on the surface. 
As the ulceration eats through one lamella of the valves, the 
lamella? underneath stretch and bulge out by the strain of circu- 
lation and cause the so-called Valvular aneurisms, which, when 
situated on the auriculo-ventricular valves, project into the auri- 
cles, or when on the semilunar valves, into the ventricles ; they 
may enlarge to such a degree, as to form an acute stenosis of the 
ostium. Ulceration in the ventricles, when complicated with 
myocarditis, may lead to a so-called Partial cardiac aneurism: 
when situated at the septum, may cause perforation of the same 
and establish a communication between the two ventricles : the 
particles of the crumbling masses in the left ventricle may be 
swept into the terminal arteries and valveless veins of the spleen, 
kidneys, brain or eyes, producing infarctions in these organs, or 



ENDOCARDITIS. 445 

when arising from the right side of the heart, bring about ab- 
scesses from embolism in the lungs. 

The symptoms of ulcerative or diphtheritic endocarditis may 
be similar to a typhoid or pysemic fever; the heart-symptoms are 
not characteristic. Usually, however, we hear a loud, systolic 
and occasionally a diastolic murmur, loudest at times over the 
apex, at other times over the base, and especially in the neigh- 
borhood of the aortic ostium. Of course, in complication with 
pericarditis the physical signs change accordingly. For this 
reason endocarditis may easily be confounded with typhoid fever, 
for in both, the spleen is almost always enlarged, and a roseolar 
or petechial exanthema is very often present, and frequently ac- 
companied by meteorism. But endocarditis has not the charac- 
teristic typhoid curve of temperature, exhibits a remarkable fre- 
quency of the pulse and is usually found in connection with 
rheumatic arthritis, puerperium, chronic valvular disease, pyae- 
mia and traumatic diseases in general. 

2. The Verrucose form of endocarditis is also more prevalent on 
the left side of the heart, and takes its favorite seat on those sur- 
faces of the valves which face the current of the blood; then we 
see it occur on the chordae tendinae and relatively seldom on the 
lining of the ventricles. The verrucose products are the fruit of 
inflammatory changes in the parenchyma in consequence of irri- 
tation. They consist of proliferations of the connective tissue, 
and appear either as a mere velvety coating on the smooth valvu- 
lar surfaces, or amount to opaque spots with wart-like, papillous, 
knotty and cauliflower-shaped excrescences of a red or gray-red 
color, firm at the base and soft or jelly-like at their points. Parts 
of these growths may be driven into the general circulation and 
form emboli. From the left side the kidneys are the organs 
most liable to infarction, while in affections of the right heart 
the inferior lobes of the right lung are most liable to be invaded. 

A T errucose endocarditis is almost always accompanied by peri- 
carditis, and most frequently complicated with rheumatic ar- 
thritis; it also has been found the offspring of childbirth and 
pregnancy, of old valvular affections, and of acute exanthematic 
diseases. 

Its invasion, during these different affections, generally takes 
place unnoticed; because it is quite seldom that the patient com- 
plains of pain in the region of the heart when attacked in this 
way. But once established, we observe the following symptoms: 



446 DISEASES OF THE ENDOCARDIUM. 

1. Palpitation of the heart, and soft, easily compressible and small 
pulse. 

2. Dyspncea, which is the greater the more the respiratory or- 
gans become involved in the morbid process, causing quick and 
unequal respiration, fainting, or congestion of the brain, with 
headache, delirium, sleeplessness, sopor. 

3. Higher degrees of endocarditis are frequently attended by 
icterus. 

Its physical signs are the following: 

1. The normal sounds of the heart are stronger, and audible 
over a larger space than natural — in the beginning of the disease. 

2. In place of the first tick we hear, at the apex of the heart, a 
noise, which shows that the mitral valves have become diseased. 

3. The second tick of the pulmonary artery is increased in conse- 
quence of the insufficiency of the mitral valves, causing an over- 
flow in that artery. 

4. Percussion at first reveals nothing, but at a later period 
yields a dull sound over a greater space than natural, because of 
the dilatation of the right ventricle in consequence of impeded 
circulation. 

Both forms of endocarditis may result in recovery, but gener- 
ally leave diseases of the valves, either thickening, adhesion, or 
perforation, and in consequence hereof, dilatation and hypertro- 
phy of the heart. 

THERAPEUTIC HINTS.— Compare what has been said under 
Pericarditis. The characteristics of the remedies acting upon 
the heart, must be applied here too. In addition, I shall mention 
only— 

Spigel., the most important; waving palpitation, not synchro- 
nous with the pulse; pulsating and trembling carotids; purring 
feel over the heart; rheumatism. 

Aurum, rheumatic pains, previously wandering from joint to 
joint, become fixed in the region of the heart and cause great 
anxiety; the patient has to sit perfectly quiet in an upright po- 
sition; palpitation, with irregular, intermitting pulse and short 
breath, feeling as though the heart ceased beating for a while, 
and then at once one hard thump is felt. 

Bismuth., has not yet been tested in practice, but its'pathological 
effects seem strongly to indicate it; they are: inflamed spots in 
the endocardium, black coagulum in the heart. 



ENDOCARDITIS. 447 

Iodium, accoi'ding to Kafka, if Spigel. has failed to act favorably 
during 24 to 36 hours. 

Kali carb., where, in place of the first tick, a blowing noise and 
a louder second tick of the pulmonary artery is heard (Kafka); 
where there consequently exists already a stagnation in the pul- 
monary circulation. 

Spongia, in consequence of endocarditis, attacks of severe op- 
pression and pain in the region of the heart; all symptoms worse 
from lying with the head low; inability to lie down at all. 

In consequence of Endocarditis originate diseases of the valves; 
which consist either in — 

1. Insufficiency of the valves ; or in — 

2. Constriction of the valvular openings. 

1. Insufficiency of the Mitral or Bicuspid Valve. 

Mostly in consequence of endocarditis the valves become short- 
ened and thickened, sometimes by flat calcareous substances stif- 
fened and the fine fringes on their free borders obliterated; at 
other times the valves are torn from the chordse tendinese; sel- 
dom are the chordae tendineee grown fast to the wall of the ven- 
tricle; not unfrequently the capillary muscles are in a state of 
callous degeneration. 

There are also characteristic changes of other parts of the heart 
attending this disease, namely: always a dilatation and hyper- 
trophy of the left auricle, of the pulmonary veins and artery and 
of the right ventricle and auricle. 

In consequence of these defects of the mitral valves, the blood 
regurgitates during the systole into the left auricle, thus check- 
ing the normal flow of the blood through the pulmonary vein. 
This causes an accumulation of blood in the lungs, in conse- 
quence of which the blood is pressed backwards into the pul- 
monary artery, causing here a widening of its volume, and, in 
consequence, a louder second tick. This increased second tick 
of the pulmonary artery is the most characteristic sign of insuf- 
ciency of the mitral valves. 

The check of circulation in the lungs causes further dilatation 
and hypertrophy of the right ventricle, because it requires greater 
power to force on the accumulated and obstructed blood. By- 
and-by, however, this increase of power in the right ventricle 
diminishes again, and thus the veins of the lungs become perma- 



448 DISEASES OF THE ENDOCARDIUM. 

nently overcharged with blood; the same result takes place in 
the venae cavae, and, in consequence, the liver, spleen and kidneys 
grow hyperaemic, which finally ends in dropsy. This stagnation 
of blood in the lungs causes also dyspnoea, bronchial catarrhs, 
periodical haemorrhages from the lungs, passive hyperaemia of 
the brain, an undulation of the jugular veins, cyanosis, jaundice 
and dropsy, which usually commences in the lower extremities 
growing gradually upwards. 

The characteristic physical signs are the following : 

1. In place of the systolic sound we hear a noise at the point 
where the apex strikes at the thoracic wall. 

2. The diastolic of the pulmonary artery is much increased. 

3. The dull percussion sound of the heart extends further in 
breadth, on account of the dilatation of the right ventricle. 



2. Constriction or Stenosis of the Left Auriculo-Ventricnlar Opening-. 

It originates mostly in this way that the mitral valves shrink 
and grow harder and narrower, or that their points grow to- 
gether, or that the chordae tendineae adhere to the valves, or that 
the valves become covered with calcareous substances. This state 
of things naturally produces at the same time insufficiency of the 
mitral valves and therefore we find in the great majority of cases 
stenosis complicated with insufficiency. The other changes in 
the heart are like those of insufficiency; the left ventricle, how- 
ever, grows smaller and the aorta narrower on account of the 
diminished flow of blood through them. 

As in this case the narrowed and roughened orifice does not 
allow the blood to enter freely into the left ventricle, its passage 
through this opening is perceptible to the ear — we hear during 
the diastole a noise at the apex of heart. At the same time the 
narrowed opening prevents the normal quantity of blood from 
passing through into the left ventricle, which causes an accumu- 
lation of blood in the left auricle; hence, a check of flow in the 
pulmonary vein: hence, an overfilling of the lungs; hence, a 
greater backward pressure into the pulmonary artery; and hence 
all the consequences which I have detailed under the head of 
defective mitral valves, only much more rapid and much more 
intense. 

Its characteristic physical signs are the following : 

1. "We hear at heart's apex instead of the diastolic sound a 



ENDOCARDITIS. 449 

noise. This noise is sometimes similar to the purring of a cat, 
so that it even may he felt. 

2. The diastolic sound of the pulmonary artery is louder. 

3. The dull percussion sound of the heart extends further to 
the right, on account of dilatation and hypertrophy of the right 
ventricle. 

In cases where the mitral valve is defective and the left auri- 
culo-ventricular opening constricted at the same time, then we 
hear a noise during the systole as well as during the diastole. 
The sound of the aorta is mostly weak. The pulse is in most 
cases weak, not corresponding to the violent palpitation of the 
heart. 



3. Insufficiency of the Aortic Valves. 

As soon as these valves do not shut tightly, the blood which 
has been driven during the heart's systole into the aorta, rushes, 
during its diastole, back into the left ventricle, causing an abnor- 
mal quantity of blood to collect there. To get rid of this the left 
ventricle has to make greater efforts to rid itself of it ; and, in 
this way, it gradually grows wider and thicker — eccentric hyper- 
trophy of the left ventricle. By this increased capacity of the left 
ventricle the consequences of the defective aortic valves become, 
so to speak, counterbalanced. For a good while it prevents an 
overfilling with blood in the pulmonary veins; w T e observe no 
slowness of pulse, no decrease of arterial blood, no cyanosis or 
dropsy. For, although the defective valves retard the circula- 
tion and make the blood venous, the hypertrophy of the left ven- 
tricle hastens the circulation and makes the blood arterial again. 

Therefore, we find that patients thus affected suffer at first com- 
paratively little ; the most frequent signs are, congestion of the 
brain, which manifests itself as dizziness, noise in the ears, flick- 
ering before the eyes, headache, hallucinations, red face, etc., as a 
consequence of the hypertrophied left ventricle. 

Later, however, the increased capacity of the left ventricle is 
not sufficient longer to overcome the consequences of the defec- 
tive valves, and thus all the symptoms of impeded circulation, as 
described above, commence to set in. The characteristic physi- 
cal signs of defective aortic valves are the following : 

1. Diastolic noise of the aorta, in consequence of the regurgita- 
tion of blood into the left ventricle during the heart's diastole. 



450 DISEASES OF THE ENDOCARDIUM. 

2. Greater extension of the dull percussion sound in the heart's 
long axis, on account of the hypertrophy of the left ventricle. 

3. Arched appearance of the region of the heart for the same 
reason. 

4. The impulse of the heart's apex is felt lower down and out- 
side of the nipple line. 

5. Strong, jumping pulsation of the carotid arteries. 

6. Short, jerking, wiry pulse. — Traube adds : 

7. The sounding of the crural artery. 

8. The rough systolic after-noise in the carotids. 

9. The want of the systolic sound at the heart's apex. 

4, Constriction or Stenosis of the Aortic Opening. 

The disturbance of circulation is, in such a case, of course, still 
greater than by mere defect of the valves ; and, therefore, the pa- 
tient soon shows symptoms of deficient circulation ; such as pale- 
ness, small, thread-like pulse ; fits of fainting ; coolness of the ex- 
tremities ; anaemia of the brain. At a later period the veins be- 
come overcharged with blood, and in consequence we find the 
patient suffer with dyspnoea, cyanosis, and all the other symp- 
toms of heart disease. 

Its characteristic physical symptoms are: 

1. Systolic noise, which is often heard in the carotid. 

2. Dull percussion sound, somewhat extended in the direction 
of the longitudinal axis of the heart. In consequence, dilatation 
and hypertrophy of the left ventricle. 

3. Apex lower down and outside of the nipple line. 

4. Pulse small, wiry, irregular and thread-like. 

In case there exists at the same time a defect in the aortic 
valves, we may also hear a diastolic noise. 

5. Insufficiency of the Tricuspid Valves. 

This defect allows the blood to regurgitate into the right 
auricle, when the heart contracts. Thence the retrograde stream 
of blood goes into the vena? cavse and jugular veins: hence we 
feel a pulsation of the jugular vein, synchronous with the arterial 
pulse. This retrograde motion of the blood causes overfilling of 
all the veins, and its consequent results are hyperaemia, cyanosis, 
hydrops, etc. 



ENDOCARDITIS. 451 

Its characteristic physical signs are: 

1. Systolic noise in the right ventricle. 

2. Swelling and pulsation of the jugular reins. 

3. More extended dull ■percussion sound in the direction of the 
breadth of the heart on account of its right auricle having become 
enlarged and hypertrophied. 

This complaint is generally a secondary affection, in conse- 
quence of diseases of other valves; and then, of course, is attended 
by all the above-mentioned disturbances and signs. 

6. Stenosis of the Right Auriculo-ventricular Opening, 

7. Insufficiency of the Pulmonary Valves, 

8. Stenosis of the Pulmonary Opening 

are, uncomplicated, of such rare occurrence, that even Skoda 
did not observe them on the living. Skoda, p. 371. 

The Treatment of all these different valvular affections has to 
be adapted to each single case, and it is not the diseased valve 
which points to any particular remedy, but the individual 
symptoms by which the whole morbid process manifests itself. 

Still I might give some general dietetic rules, which are of 
great importance for the treatment of these different affections. 

Patients in whom we find symptoms of congestion of the brain 
or chest, ought not to eat much animal food; must avoid all 
sorts of stimulants, and especially coffee, and all kinds of spices. 
Mental excitements and depressions are alike hurtful to them ; 
and neither too high nor too low a degree of temperature is 
advisable. 

Patients, however, in whom ansemia and debility prevail, ought 
to eat animal food and drink beer or wine; ought not to over- 
exert themselves, and ought to have all the fresh, pure air they 
can get. 

Aeon., usual symptoms of great restlessness, anxiety, fear of 
death, stitch-pains, haemoptysis with hacking cough, etc. 

Act. rac., catching pain in region of heart, worse on moving or 
bending forward, preventing inspiration; palpitation and faint- 
ness; sexual disturbances in females. 

Arnica, heart feels as if bruised; palpitation from any exertion. 

Arsen., prsecordial anxiety and oppression; palpitation at night 
with anguish, cannot lie on back; after suppressed eruptions or 
foot-sweat. 



452 DISEASES OF THE ENDOCAEDIUM. 

Cact. grand., livid complexion, sunken face; difficult breathing, 
worse from exertion/; constant pain, darting and cutting from 
region of heart to the left shoulder and down the arm, worse 
from damp weather or any emotion; oedema, especially of left 
hand and legs up to the knees; icy cold feet; intermittent pulse. 
Insufficiency of mitral valves. 

Calc. carb., trembling pulsation of the heart, worse after eating, 
at night with anguish; inclination to take deep breaths; menses 
too early and too profuse. 

Digit., irregular, intermittent beats of the heart; very slow 
when keeping still, but easily accelerated by any exertion; feel- 
ing at times as if the heart stood still, with great anxiety, oedema 
of the lungs; bluish-red face, or death-like appearance. 

Ferrum, cblorotic symptoms; congestion of the head; spitting 
of blood; palpitation, better from slowly moving about. 

Grelsem., "fears that unless constantly on the move her heart 
will cease beating." 

Kali hydr., darts in the region of the heart when walking; after 
mercurial poisoning; after repeated attacks of inflammation of 
the heart. 

Laches., restless, trembling; anxiety about the heart; hasty 
speech; suffocation on lying down; weight on the chest; heart 
feels constricted; numbness of left arm. 

Lil. tigr., heart feels as if grasped, with pain and heaviness of 
left mamma to scapula; pulsations over whole body, and out- 
pressing in hands and arms, as if blood would burst through the 
vessels; fluttering, awakens her at night, with cold hands and 
feet covered with cold sweat, with sharp, quick pain in left chest. 

Lithium, soreness about the heart, worse stooping; pain in the 
limbs; finger-joints tender and painful; sleeplessness. 

Natr. mur., irregularly intermitting pulsation; fluttering of the 
heart, with weak, faint feeling and necessity to lie down; cold- 
ness of hands and feet; numbness of hands relieved by rubbing; 
cutting pain in urethra after micturition ; scanty menses. 

Phosphor., congestion of the lungs; tightness across the chest 
and tight cough ; spitting of blood ; palpitation worse after eating, 
or mental emotion ; yellow spots on the chest : painless diarrhoea. 

Psorin., stenosis of left osteum venosum ; purring in the region 
of the apex; cyanotic lips; dyspnoea and shortness of breath 
when walking in open air; better when lying down. 

Rhus tox., palpitation worse during rest ; pain from region of 
the heart into left arm, with numbness; rheumatism. 



HEART-CLOTS. 453 

SpigeL, stitches about the heart; anxiety and oppression: can 
only lie on right side, or with head very high ; least motion 
aggravates. 

Spongia, violent palpitation, awakens after midnight with a 
sense of suffocation ; loud cough, great alarm, agitation, anxiety 
and difficult breathing; violent gasping respiration ; pain in tbe 
heart. 

Besides compare: Anac, Iodium, Kali carb., Lycop., Naja, 
Plumbum, Pulsat., Sepia, Sulphur, Veratr. 

Heart-clots. 

Fibrinous coagulations, especially in the right ventricle and 
auricle, are very frequently found on post-mortem examinations. 
If they have originated recently, either soon after death or dur- 
ing death-struggle, they are of a whitish-yellow, generally trans- 
lucent appearance, frequently jelly-like in consistency, moist and 
shiny, as if cedematous, and infiltrated with blood on their lower 
surface ; they may extend into the vessels and be drawn out like 
strings or cords, and can easily be separated from the subjacent 
parts without injury to either ; they are the result of the natural 
coagulation of the blood during the retardation and final cessa- 
tion of its current. 

But clots may also form during life, either in consequence of a 
slackening in the current of the blood from some obstruction or 
loss of propelling force ; or in consequence of gradual deposition 
of fibrine on roughened surfaces produced by vegetations or in- 
flammatory processes of the inner wall of the heart ; or in conse- 
quence of fibrinous coagula from distant portions of the vascular 
system, serving as nuclei for more extensive fibrinous clots ; or 
perhaps also in consequence of an increase of fibrine in the blood 
during certain diseases, or a greater tendency of the blood to 
coagulate. 

These clots, called True polypi of the heart, are dull in appear- 
ance, dry, rotten, friable, of a whitish-yellow, or gray color, con- 
sist of various layers of different color and contain at times de- 
posits of lime salts and in their centre a purulent fluid. They 
are of various sizes, and usually firmly attached to the inner 
walls of the heart ; they are found particularly at the apex of the 
left ventricle and in the appendices of the auricles. 

The Symptoms of this affection are not characteristic enough to 



454 DISEASES OF THE HEART-MUSCLE. 

distinguish it from other heart affections, with which it may be 
complicated. Heart-clots may occasion sudden death in patients 
previously in apparent good health. 

In other cases they may produce dyspnoea, cyanosis, or pallor 
of the whole surface, expectoration of bloody sputa, coldness of 
the extremities, stupor, convulsions, loss of consciousness, death. 
The heart's action usually is slow, seldom irregularly violent. 
Dropsical effusions may occur if the patient survives long enough. 
The physical signs which are occasioned by the clots are of no di- 
agnostical value. The presence of heart-clots may, therefore, be 
guessed at but cannot be positively proven. 



III. DISEASES OF THE HEART-MUSCLE. 
Myocarditis, Carditis, Inflammation of the Heart-muscle, 

Is found always in connection with peri- or endocarditis ; and 
then, its seat is generally the left ventricle. The substance of 
the muscle appears yellowish ; sometimes fatty degenerated. Its 
most frequent occasion is acute rheumatism of the joints, but it 
has also been observed in the course of puerperal and exanthe- 
matic fevers. 

There are no characteristic signs of this complaint, because it 
is almost always mixed up with peri- or endocarditis. Mild forms 
pass over without any consequences; but if it extends to the for- 
mation of abscesses, it may cause widening of the heart-muscle, 
(partial aneurism,) or bursting of the heart-muscle, and conse- 
quent sudden death. When the abscess discharges into the ven- 
tricle it causes the formation of emboli, with their consequences. 

Hypertrophy and Dilatation of the Heart. 

Hyertrophy consists of an increase in mass of the heart-muscle, 
or a thickening of its walls, whereby the inner cavity becomes 
narrower: this is the so-called concentric hypertrophy; or the heart- 
muscle is increased in thickness, and the inner cavity widened at 
the same time: this is the so-called eccentric hypertrophy. 

When, however, the inner cavity is widened, and the heart- 
muscle at the same time has grown thinner, it is called dilatation 
of 'the heart. 

The most frequent of these three forms of altered conditions is 
eccentric hypertrophy. 



HYPERTROPHY AND DILATATION OP THE HEART. 455 

But it is not always the whole heart that is enlarged or dilated ; 
it is generally only one-half of it that is thus affected. A hyper- 
trophied left ventricle makes the heart longer, reaching further 
down in the left thorax, while an eccentric hypertrophy of the 
right ventricle makes the heart broader, so that it reaches further 
over into the right thorax. 




Hypertrophy of 


Left Ventricle. 


Eccentric Hypertrophy of High 


r Ventricle 


Heart elongated. 




. a. Heart widened. 




Liver. 




6. Left lung. 




Stomach. 




c. Right lung. 




Lungs. 




d. Enlarged liver. 

e. Stomach. 

/. Enlarged spleen. 





Both, hypertrophy and dilatation, are most frequently caused 
by disturbed circulation, in consequence either of diseases of the 
valves or diseases of the arteries, like aneurism, or obstacles in 
the capillaries in the lungs. Also pericarditis and myocarditis, 
mental excitements, strong coffee, tea, and spirituous liquors have 
been found exciting causes of this complaint. 

Eccentric hypertrophy of the left ventricle manifests itself by an 
increased impulse of the heart, either heaving in character or 
jarring the chest- wall, more or less towards the left of the nip- 
ple-line and further down, in some cases even as far as the seventh 
and eighth intercostal space ; it is an enlargement of the heart in 
its long axis, and causes sometimes an intensification of the sounds, 
especially of the second sound in the aorta, sometimes a metallic 
clink, increased pulsation of the carotids, murmurs in the larger 
arteries and also in the small vessels far removed from the heart, 
and a pulse perceptibly larger in volume under the finger." 

"In hypertrophy of the'right ventricle, the heart's impulse is not 
increased, except occasionally near the lower portion of the ster- 
num ; the apex beats further to the left, but not lower down. The 



456 DISEASES OF THE HEART-MUSCLE. 

area of dulness is increased in breadth, and the second sound in 
the pulmonary artery is accentuated." 

" In total hypertrophy we find a combination of symptoms cor- 
responding to the hypertrophy of the ventricles. It is seldom, 
however, that we can succeed in declaring with accuracy which 
half of the heart is the more enlarged." (Schroeter.) 

Dilatation is found more frequently of the right than of the left 
ventricle. The impulse of the heart is, as a rule, weaker than 
normal. There follows retardation of circulation, and conse- 
quently dyspnoea, cyanosis and dropsy. Pulsation of the veins 
of the neck are characteristic to a dilatation of the right auricle. 

THERAPEUTIC HINTS.— Compare what has been said of the dif- 
ferent affections of the heart. As hypertrophy is more or less a 
consequence of the one or the other, the characteristic indications 
of the different remedies there described must also fit here. I 
have only to add : 

Arsen., dilatation of right ventricle, with swelling of legs and 
vertigo ; scanty urine without albumen. 

Plumb, ac, stitch in the region of the heart during an inspira- 
tion, with anxiety ; heat and redness of the face ; rushing of 
blood in the region of the heart during a rapid walk ; anguish 
about the heart, with cold sweat ; palpitation of the heart. 

Post-mortem, after poisoning, has shown that the serous coat of 
the pericardium is lined with a layer of reddish-gray, fine villous, 
meshy, firm, exuded lymph. The heart is more than double its 
natural size. The wall of the left ventricle is more than an inch 
thick. 

Kalmia lat, after rheumatism ; hypertrophy; palpitation; dysp- 
noea; pain in the limbs; stitch-pain in the lower part of the 
chest ; prosopalgia on right side. 

Fatty Heart and Fatty Degeneration of the Heart. 

Under Fatty heart is understood an accumulation of fat in the 
subpericardial connective tissue, at the apex, in the ventricular 
furrows along the course of the vessels, at the base around the 
junction of the auricles and ventricles, at the origin of both the 
great vessels, and at times embracing the whole heart like a cap- 
sule of fat. By its spreading along the course of the fibres of the 
connective tissue in between the muscular bundles it causes the 



FATTY DEGENERATION OF THE HEART. 457 

latter to atrophy and appear as thin pale stripes and layers. It is 
usually accompanied with a simultaneous deposit of fat through- 
out the system, especially in drinkers. 

The Fatty degeneration of the heart takes place in the primitive 
bundles of the muscular fibres themselves ; they appear cloudy 
and their transverse striae disappear; the heart substance thereby 
becomes pale and yellowish in color, and its texture flabby and 
friable. It may be acute and chronic. Its Causes are : various 
chronic diseases, protracted suppuration, great loss of blood, tu- 
bercular and cancerous cachexia, severe forms of syphilis, pro- 
found anaemia, and also diseases of the heart itself, such as peri- 
carditis, endocarditis, valvular lesions, chronic parenchymatous 
myocarditis. Its acute form occurs after puerperal, typhoid, re- 
mittent and exanthematous fevers, after yellow atrophy of the 
liver and Bright's disease, also in consequence of poisoning with 
j)hosphorus, mineral and vegetable acids and alcohol. 

The Symptoms of this disease are in no-way very characteristic. 
Its acute form is usually obscured by the attending primary dis- 
ease, and a deposit of epicardial fat, which leads to atrophy of the 
muscular tissue, cannot be distinguished from the true fatty de- 
generation. Still its occurrence especially in advanced age, in 
corpulent people, its usually feeble impulse and pulse, its occa- 
sional attacks of dizziness and fainting, the presence of the arcus 
senilis may, by a careful exclusion of all other diseases in which 
similar symptoms occur, lead to a correct diagnosis. 

Both forms may exist for many years if they act only partially 
destructive to the heart-muscle, or are kept in check by judicious 
treatment; death may occur from paralysis or rupture of the 
heart. 

THERAPEUTIC HINTS.— An undue accumulation of fat should 
be prevented by a judicious diet, avoiding fat meat, butter, milk 
and such articles which consist principally of starch and sugar. 
Allowable are lean meats, fish, vegetables. Of drinks, malt-liquors 
should be forbidden, while red wines, claret and the like moder- 
ately used may be of benefit. Water is the safest drink. In case 
of syncope an alcoholic stimulant may be of use, and for the spells 
of dizziness, the stooping with the head low down between the 
knees has been found of great benefit, because it helps mechani- 
cally to bring, a sufficient quantity of blood to the brain, which 
the weakened propelling force of the heart alone is not capable of 



458 NERVOUS AFFECTIONS OF THE HEART. 

doing. -For the same reason in case of syncope the head should 
be put low. Among the remedial agents we may especially turn 
our attention to remedies that have proved beneficial to persons 
in whom a tendency of growing fat was manifest, e. g., Arsen.. 
Calc. carb., Ferrum, Sulphur. 

Arnica, recommended by Kafka. 

Aur. mur., has relieved when there was a peculiar hacking cough 
with weak impulse, also where a pain existed as if from angina 
pectoris attended with blood-spitting. 

Digit, where there is slow or irregular action of the heart. 

Phosphor., produces all the symptoms of fatty degeneration in 
different parts of the body. 

IV. NERVOUS AFFECTIONS OF THE HEART. 
Nervous Palpitation of the Heart 

Is an increased action of the heart without any detectable organic 
lesion of that organ. 

The heart's activity is accelerated by irritation of the ganglia 
which we find imbedded in its substance; by irritation of the 
cardiac branches of the ganglion stellatum, which take their ori- 
gin from fibres of the cervical portion of the sympathetic: by 
irritation of the nerve fibres which originate in the medulla 
oblongata, run down the spinal cord, pass out from the cord with 
the spinal nerves and become entwined with the sympathetic! 
and by irritation of the sympathetic in general, causing a con- 
traction of the vessels, and thereby an increased blood pressure 
in the aortic system with consequent increased labor of the heart. 
These are the exitor nerves of the heart's activity; its restraining 
or inhibitory forces rest in the pneumogastric and its ramifica- 
tions. An irritation of the vagus slackens the movements of the 
heart in frequency, but a division of the vagi increases this fre- 
quency for the reason that then the exitor nerves have no 
restraining power to overcome. 

The blood too as regards its quantity, as well as its quality, has 
a powerful influence on the action of the heart. 

The Special Causes of palpitation are: mental excitements of 
all kinds, such as fear, joy, anger and the like; diseases of the 
brain and spinal cord of various kinds, amongst them: hyper- 
semia and inflammation of these organs, psychoses, hypochondria. 



NERVOUS PALPITATION OF THE HEART. 459 

hysteria, exhaustion from protracted night-watching, or venereal 
and other excesses; diseases of the abdominal cavity, such as 
accumulation of gas in the intestines, worms, gall-stones, renal 
calculi and affections of the genital apparatus; partial hypere- 
mia from suppressed menstrual or hemorrhoidal flow; chlorosis 
and anaemia, and first stages of consumption, gout and different 
drugs, especially alcohol, coffee, tea and tobacco. 

Nervous palpitation of the heart is at times attended with 
dyspnoea, distress and even pain in the chest, with throbbing of 
the carotids, flushing of the face, or (oftener) with pallor and cold 
sweat, with dizziness, faintness, and specks or flashes of light 
before the eyes. Some persons cannot lie down, must sit up, or 
cannot lie on the left side. Auscultation often reveals the first 
sound increased and of a metallic quality; "the second sound is 
wanting only in cases of tremendous acceleration of the heart's 
movements, where the heart has not had time fully to complete 
its diastole." (Schroeter.) 

After the attack the absence of murmurs, or of enlargement of 
the heart, establishes its Diagnosis. The presence of a diastolic 
murmur excludes the diagnosis of a simple nervous palpitation, 
because such murmurs never occur without organic changes in 
the heart. 

Its Prognosis depends entirely on the nature of the underlying 
cause; if that is removable, its effect will cease. In old people 
with atheroma of the arteries, it may end with apoplexy. 

THERAPEUTIC HINTS.— Aeon., in young subjects; after fright; 
after wine. 

Arsen., after suppressed herpes circinatus and suppressed per- 
spiration of the feet. 

Aurum mur., palpitation, sleeplessness, depression of spirits, with 
thoughts of suicide, constipation. Motion, wine or beer have no 
influence. 

Asaf., in women, after suppressed discharges, or bodily exer- 
tions, with small pulse; breathing not oppressed. 

BeUad., with congestion of the head. 

Benz. ac, worse at night and when lying; alternating with tear- 
ing rheumatic pains in the extremities. 

Cact. grand., palpitation is preceded by rumbling in the stomach ; 
pains in shoulders and arms; change of life. 

Calc. carb., after suppressed eruptions and pimples on the face ; 



460 NERVOUS AFFECTIONS OF THE HEART. 

onanism. Cold lower extremities; vertigo on going up stairs, or 
up a hill ; bloating in the pit of the stomach ; craving for boiled 
eggs; copious menstruation. 

Camphora, when attended with coldness of the skin; cold ex- 
tremities; paleface; and sudden oppression of breathing. 

China, great weakness from loss of vital fluids ; long-continued 
nursing. 

Coccul., tremulous palpitation from quick motion and mental 
excitement, with dizziness and faintness. 

Coffea, after excessive exaltation, joy, surprise. 

Digit, attended with apncea, danger of suffocation; yellow and 
blue face, worse from motion, from moving the arms. 

Ferrum, anaemia; throbbing in all the blood-vessels; soft bel- 
lows-sound at the apex, with anxiety in chest and heat rising 
from pit of stomach; with fear; after bodily exercise; also must 
move about, can neither sit nor stand. 

Graphit, amenorrhcea; pimples on the face about the menstrual 
period. 

Kali carb., throat feels as if squeezed, as if the lungs came in 
the throat; stitch pain and anxiety in pit of stomach and through 
the chest; pale grayish color of the face; dizziness in walking; 
cold feet; scanty menses. 

Merc, sol., wakes with nervous trembling; thumping of the heart 
and agitation as if he had been frightened ; weakness at the heart, 
as if dying. 

Moschus, when combined with hysterical symptoms. 

Nux mosch., paroxysms after midnight, as if the heart were stop- 
ping, and then beating violently, with loud belching; better from 
drinking hot water and keeping warm; must walk about. Hys- 
teria. 

Nux vom., after coffee, wine, liquors, spices. 

Natr. mm*., fluttering, long-standing chlorosis, with torpid skin 
and suppressed menses. 

Nitr. ac, when caused by the slightest mental excitement. 

Opium, after alarming events, causing fright, grief, sorrow, etc. 

Phosphor., dyspnoea, tightness across the chest, great weakness, 
and after any little mental excitement; violent hammering in 
the chest, aggravated by motion, benumbing all over. 

Phosph. ac, in children and young persons who grow too fast : 
after self-abuse, long grieving. 

Pulsat, young girls during the time of puberty ; from suppressed 
menses. 



ANGINA PECTORIS, STENOCARDIA. 461 

Rhus tox., always worse when being quiet. 

Secale, with profuse menstruation of a watery discharge; after 
sexual excesses; comes in paroxysms with spasmodic shocks from 
right side of chest into right arm and leg; coldness and numb- 
ness of right hand and stinging in fourth and fifth fingers; worse 
at night, after each meal; better in open air. 

Sepia, tremulous, intermitting pulsation; suppressed menstru- 
ation. 

Silic, always after quick or violent motions, such as playing 
ball, etc.; panaritia. 

Thea, after exciting talk and mental exertions, with sleepless- 
ness. 

Ver. alb., headache, nausea, vomiting, diarrhoea; bleeding of 
the nose occasionally; cold perspiration on forehead. 

Angina Pectoris, Stenocardia, 

Is characterized by: "Pain in the region of the heart, occurring 
in paroxysms, which usually radiates over the left side of the 
thorax and the left arm, more rarely over both sides and arms; 
the pain is associated with peculiar sensation of anxiety and con- 
striction, and often also with other motor, vasomotor and sensi- 
tive disturbances." (Eulenburg). 

It is often complicated with organic diseases of the heart, such 
as: faults in the valves, or fatty degeneration of the heart, or 
atheromatous processes in the aorta, or ossification and contraction 
of the coronary arteries. In its real nature, however, it is a 
neurosis and may be classed according to its symptomatology, 
with the visceral neuralgias, including cardialgia, colic, hyster- 
algia, etc. For this reason it may be divided : 

1. In a Ganglionic angina pectoris, when there is either an irrita- 
tion of the excitomotor nerves with acceleration of the pulse, or 
a paralysis of the same with retardation of the pulse. 

2. In a Regulator angina pectoris, when there is either an irrita- 
tion of the vagus with retarded but full and hard pulse, increased 
force of impulse of the heart, sometimes a temporary arrest of 
the same and disturbance of phonation and deglutition; or, more 
rarely, a paralysis of the vagus with acceleration of the pulse. 

3. In a Reflex angina pectoris, when there is a reflex neurosis of 
the vagus from diseases of the abdominal organs with the symp- 
toms of irritation of the vagus. 



462 NERVOUS AFFECTIONS OF THE HEART. 

4. Iii a Vaso angina pectoris, when there is either an irritation 
of the vasomotor nerves which run in the sympathetic, with 
contraction of the vessels and increased pressure causing arterial 
anaemia, paleness and coldness of the skin and but little acceler- 
ation of the pulse, if any; or, more rarely, a paralysis with 
opposite symptoms. 

These principal types will, in given cases, not always be so 
clearly expressed, that a recognition or distinction between them 
could be called an easy matter; the great variability of the cir- 
culatory symptoms during an attack of angina pectoris on the 
contrary hints to the possibility that there exist manifold com- 
plications between these different types. Of greater practical 
importance, however, is it to find out whether these attacks be 
complicated, as thej r often are, w T ith an organic disease of the 
heart, or of an abdominal organ, or whether they be a pure 
neurosis. If the latter, the prognosis is more favorable, than in 
the case of such complications where it entirely depends upon 
the nature of the latter. 

THERAPEUTIC HINTS.— E. T. Blake advises the patient on the 
advent of an attack to take a deep inspiration, and if possible to 
hold the breath; to use no tea, tobacco, etc., and to avoid all 
unusual exertions or violent emotions. 

Kafka gives the following hints: 

Aur. mur. 3 , where there is hyperaemia in consequence of stagna- 
tion of blood in the heart. 

Glonoin. 3 , as an intercurrent remedy to prevent the orgasm from 
getting accustomed to the influence of Aur. mur. 

Agar. 3 , in the gastralgic or spasmodic form. 

Kali carb., when Agar, seems to lose its favorable influence; in 
other cases, however, Carb. veg., or Lact. vir., or Lycop., are better 
indicated than Kali carb. 

Sambuc. 3 , where the pressure proceeds from the spine; in indi- 
viduals formerly fat and robust and now emaciated in consequence 
of mental emotions or sexual indulgence. 

Phosphor. 3 , as an intercurrent remedy, if the pressing pain is 
worse under the sternum. 

Petrol. 3 , if the pressing pain is worse between the shoulder- 
blades. 

Kali carb., is likewise indicated in this form, either alone or in 
alternation with the above. This change of remedies is best re- 



ANGINA PECTORIS, STENOCARDIA. 463 

sorted to after 8 or 12 days, if improvement seems to come to a 
standstill. 

Chin, sulph., where marasmus is a prominent symptom. So 
may also Phosphor., or Cuprum, or Ipec, or Veratr., be indicated. 

Arsen., Laches., Chin, ars., are indicated when dropsical symptoms, 
with venous hyperemia and cyanosis make their appearance. 

Nux vom., Carb. veg., are important when there is loss of appe- 
tite and accumulation of gas in the bowels. 



The following remedies have also proved beneficial : 

Aeon., anxious restlessness with fear of death ; general and lo- 
cal tingling. 

Arnica, bruised pain in region of heart ; fatty degeneration. 

Arsen., anxious restlessness with great weakness ; great thirst, 
but drinks little at a time ; great oppression ; attacks worse after 
midnight ; worse from motion. 

Cact. grand., suffocating constriction at throat, with full, throb- 
bing carotids ; wants to lie perfectly quiet on the back ; mental 
or physical exertion causes palpitation ; attacks come on also in 
sleep with anxious and frightful dreams. Fear of some organic 
lesion of the heart which will cause sudden death. 

Coca, a girl, climbing a mountain, was seized with an attack 
and became quite cold. (Richter.) 

Cuprum, attacks from excitement and exertion ; slow pulse. 

Digit, indescribable deathly anguish ; death-like feeling in pit 
of stomach ; vertigo and fainting. Pulse feeble, irregular, slow, 
intermitting ; heart's action more vigorous than pulse. 

Diosc. vill., neuralgic pain in stomach ; cannot speak ; laborious 
breathing; sudden severe pain in middle of sternum, extend- 
ing to both arms and hands ; cannot move ; cold, clammy sweat 
all over; impulse very feeble; pulseless. (F. E. Brown.) 

Hepar, when after the attack : dyspnoea ; dry, nervous cough all 
night ; pain in neck ; faintness and inability to recline. 

Laches., choking, constriction and rising in the throat; worse 
after sleep. 

Lact. vir., tightness and oppression of chest waking from sleep ; 
feels as if suffocating, must get out of bed. 

Lauroc, suffocation and gasping for breath ; violent pain in 
stomach with loss of speech ; eructations tasting of bitter al- 
monds ; cold, moist skin ; convulsions of the muscles of the face. 

Naja trip., similar to Laches. 



4G4 DISEASES OF THE AORTA. 

Ox. ac, violent irritation of the alimentary canal ; costiveness ; 
difficulty of breathing ; jerking inspiration, and sudden and 
forced expiration, as though the patient made a sudden effort to 
relieve himself of intense pain by expelling the air from the 
lungs. Oppression of the chest, especially towards the right side; 
pain on expiration ; sharp, darting or lancinating pains in the 
heart and left lung, also in the arms ; jerking pains like short 
stitches, confined to a small space, lasting for a few seconds. 
Numbness and weakness in back and limbs ; peculiar numbness 
of whole body, approaching to palsy ; coldness and complete loss 
of power of motion in the limbs. Movement excites and aggra- 
vates pain. Periodical remission for some hours or days. After 
other remedies had failed. (P. Dudley.) 

Phytol., pain goes to the right arm, or right side. 

Rhus tox., pains extending to the left arm; painful stiffness all 
over, worse in rest. 

Spigel., exceedingly sharp pain worse from any motion; fre- 
quently indicated ; also in complication with other heart af- 
fections. 

Spongia, suffocating spells at night; worse with head lying low; 
has to sit up. 

Tabac, neuralgia up into the neck; pain between the shoulders; 
pulse small, irregular, imperceptible; lividity of the skin; fea- 
tures drawn. Deathly nausea with cold perspiration. 

Ver. alb., periodical attacks of crampy pain in left chest, or cut- 
ting pain with excessive agony, extending to the shoulders; gen- 
eral prostration, skin cold and clammy. 

To all these may be added for further consideration : Aram. 
carb., Amyl. nitr., Angust., Apiol, Arg. nitr., Act. rac, Bellad., 
Bryon., Cinchona, Caustic, Hydr. ac, Ipec, Juglans cin., Moschus, 
Sepia, Stramon., Sulphur and Tarant. 



V. DISEASES OF THE AORTA. 

Aneurism of the Thoracic Aorta. 

Aneurism means a dilatation of a short piece of an artery form- 
ing a kind of sac at that place. Such dilatations are more fre- 
quently found in the aorta ascendens than in the aorta descen- 
dens. It can be diagnosticated only when it reaches the exterior 
thoracic wall. In such a case it renders that part of the chest 



ANEURISM OF THE THORACIC AORTA. 465 

perfectly dull on percussion and more resisting to the touch. 
Also, we often observe on that part a pulsating swelling with a 
peculiar kind of purring in it, which extends up into the carotid 
arteries. "We find this swelling on the right side of the sternum, 
between the second and third rib, if the aneurism is an enlarge- 
ment of the convex part of the aorta. It makes its appearance, 
however, on the left side of the sternum in the same intercostal 
space when the aneurism has formed on the concave part of the 
aorta. Its symptoms are: palpitation of the heart, dyspnoea, 
asthma, bronchial catarrh, hoemoptoe, swelling of the jugular 
veins, with cyanosis, oedema of the upper extremities, difficulty 
in swallowing, hyperemia of the brain — all symptoms in conse- 
quence of its pressure either upon the lungs or the oesophagus, 
and in consequence of disturbed circulation. 

The aneurism of the arch of the aorta has its seat behind the 
manubrium sterni, and a deep pressure with the finger into the 
fossa jugularis may detect its pulsation and purring. 

The aneurism of the aorta descendens must be very large in 
order to cause a duller sound on percussion, or a swelling between 
the left shoulder-blade and the spine. Its symptoms are the 
same as those of aneurism of the ascending aorta; and, in addi- 
tion, it may cause paralysis of the lower extremities, rectum and 
bladder. 

THERAPEUTIC HINTS.— Ergot., has been used hypodermically 
with success by Von Langenbeck "on account of its power to con- 
tract muscular fibres." Two cases (both women) of aneurism of 
the mesenteric artery are reported as having been cured by Se- 
cale. 200 (T. M. Pearce, Med. In v., 1875, Vol. 1, p. 48.) 

Lycop. 12 , is reported by R. Hughes as having cured a carotid 
aneurism in four days. (British Journal, 70, p. 792.) 

Spigel., then Carb. veg., and later Bryon. and Spigel., have cured 
a thoracic aneurism. (C. F. Nichols, New Eng. Gazette, March, 
1873, p. 106.) 

Spongia, has relieved the paroxysmal, dry. suffocative cough, 
coming at irregular intervals, especially on lying down, or drink- 
ing hot tea, also a distressing fulness in the stomach after eating 
which attended an aneurism of the descending aorta. (T. C. 
Fanning, Amer. Jour, of Horn. Mat. Med., Vol. Ill, p. 10.) 

To finish the morbid affections of the thoracic organs I have 
yet to speak of the affections of the diaphragm, that muscle which 



466 DISEASES OF THE AORTA. 

forms the partition between the thoracic and abdominal cavity, 
and which participates greatly in the acts of respiration. 



1. Diaphragmitis, or Inflammation of the Diaphragm. 

The substance of the diaphragm being a muscular, tendinous 
tissue, is scarcely ever primarily affected, while its serous lining 
on its upper surface, a continuation of the pleura and pericar- 
dium, and on its lower surface a continuation of the peritoneum, 
frequently participates in inflammations of these membranes. 
Symptoms, such as impossibility of taking a deep breath, hic- 
cough, yawning, risus sardonicus, pain in the shoulders, vom- 
iting of green masses, great difficulty in swallowing, even hy- 
drophobia, denote in pleuritis, pericarditis, or peritonitis, an 
extension of the inflammatory process upon the diaphragm. 

Physical signs, are none. 

THERAPEUTIC HINTS.— Aeon., hard, feverish pulse; thirst: anx- 
ious impatience ; restless tossing about ; painful cough; difficulty 
in breathing, and pain and heat in the upper region of the abdo- 
men. 

Apis, burning pain ; must bend forwards from a contractive 
pain in the hypochondria. 

Bellad., in plethoric persons with sympathetic affection, or in- 
flammation of the liver ; or in consequence of concrements in 
liver or kidneys; in pylephlebitis; in puerperal affections; in 
violent headache with active hypersemia. (Buchner.) 

Bryon., stitching pain in the region of the diaphragm, worse 
from any motion, from coughing; white, dry tongue without 
thirst, or else great thirst with drinking large quantities of water. 

Cact. grand., feeling as of a cord around hypochondria ; conges- 
tion to the chest; shooting pains through to the back and up 
each side of the chest; cannot lie down; dry, tickling cough as 
from dust in throat. 

Chamom., throbbing, burning pain in the region of the short 
ribs and pit of the stomach, worse from pressure; short and anx- 
ious breathing ; short, dry cough ; vomiting ; belching ; great 
restlessness ; tossing about ; loud complaining, etc. 

Colonic, similar to Bryon., for gouty persons ; albuminosis. 

Digit, after pleuritis; grasping pain; nausea and vomiting; 
oppression in middle of the chest, difficult breathing; pulse at 



SINGULTUS, HICCOUGH. 407 

first suppressed, then quick ; nails blue ; face long and cold. In 
spite of anaemia the patient can bear no high temperature. Bet- 
ter in sitting than in lying. (Buchner.) 

Dulcam., in rheumatic affections of the spinal cord. . (Buchner.) 

Hepar, after Bryon., in fibrinosis, promotes resorption. (Buchner.) 

Lycop., sense of constriction from the right side all around the 
short ribs ; cannot stretch himself nor lie upon the back ; neither 
stand upright. 

Nux vom., muscular pain of a grasping, rooting nature, with 
nausea or vomiting. 

Rhus tox., worse when lying still ; or disposition to move not- 
withstanding the pain caused by it; commencing on the left side 
and going to the right. 

Stramon., mixture of hyperaemia and spasm in consequence of 
affections of the spine and the diaphragm with hiccough, sympa- 
thetic spasms of the epiglottis and similar symptoms. (Buchner.) 

Sulphur, after Bryon., in fibrinosis, promotes resorption. 

Tabac, muscular pain caused by renal calculi when incarcer- 
ated in one of the ureters ; it contracts the longitudinal (Bellad., 
the circular) fibres. (Buchner.) 

Compare Pleuritis and Peritonitis. 



2. Singultus, Hiccough. 

Hiccough consists in a spasmodic contraction of the diaphragm, 
by which the air is suddenly drawn in, causing that sound pecu- 
liar to hiccough. Its causes may be of a cerebral origin, as in 
diseases of the brain ; it may be the consequence of anaemia from 
long-standing, weakening diseases, after great loss of blood and 
vital fluids; of strong mental affections, like fright, anger, etc. 

Or, it may be a mere reflex from diseases of the pleura or peri- 
cardium ; or it may accompany different affections of the stomach, 
the liver, the intestinal canal. If it takes place in consequence of 
exhausting diseases, like morbus Brightii, tuberculosis, typhus, 
cholera, pleurisy, with abundant exudation, large abscesses, etc., 
it is always a dangerous symptom, continues for days and may 
be the forerunner of a fatal issue. According to the different 
causes many remedies may be indicated. 

THERAPEUTIC HINTS.— Buchner gives the following: 
Arsen., after cold fruit. 



468 DISEASES OF THE AORTA. 

Hyosc., when there is inflammation of intestinal organs. 

Ignat, especially in children. 

Nnx vom„ after cold drinks. 

Pulsat, after cold fruit. 

Ruta, when associated with depression. 

Stramon., in the most obstinate forms; in children when at- 
tended with restlessness in the night and screeming during sleep. 

Ver. alb., after hot drinks. 

Also the following remedies may come into consideration; 
Amyl. nitr., Bismuth, Carb. veg., Crot. tigl., Ferrurn, Laches., 
Marum ver., Moschus, Niccol., Ranunc, Ratan., Staphis., Zincum. 

3. Neuralgias of the Diaphragm 

require Atrop., Rhus tox., Mezer.; in inveterate cases: Silic; in 
intermitting cases: Ignat. and the Alkalies in combination with 
arsenious acid. (Buchner). 

4. Rupture and Perforation of the Diaphragm. 

Ruptures are caused by violent concussions or heavy lifting ; 
whilst perforations are the result of suppurating processes either 
in the thoracic or abdominal cavity. When ruptures take place 
from out of the thorax they are generally attended by dyspnoea, 
cough, hiccough, suffocating spells and fainting. When from 
out of the abdomen, by vomiting, colic, obstinate constipation. 

Perforation takes place from suppurating processes in the tho- 
racic cavity ; for example, in consequence of pyothorax ; when 
the fluid discharges into the abdominal cavity it causes peritonitis. 



ABDOMEN 



When we examine the abdomen by sight or inspection we haVe 
to take into consideration the following conditions : 

1. Its appearance in regard to size. 

a. Enlargement of the abdomen may be partial or general. 

Partial enlargement depends upon abnormal sizes of the abdom- 
inal viscera; either the stomach, liver, spleen, uterus, ovaries, 
kidneys, glandular structures, bladder, and so on. Also, upon 
pathological products, as tumors of all kinds, encysted exudation, 
extra-uterine pregnancy, hernia, and so on. 

General enlargement may arise from oedematous infiltration of 
the abdominal walls ; or from accumulation of fat in the subcu- 
taneous cellular tissue, and the omentum; from an accumulation 
of gas in the stomach and intestines; from a collection of gas or 
fluid in the peritoneal sac; from large tumors, which fill the 
whole abdominal cavity; from pregnancy, and sometimes in 
consequence of frequent pregnancies, the so-called pot-belliedness, 
and likewise in scrofulous children from enlarged mesenteric 
glands. 

b. The abdomen appears smaller — sunken in — sometimes to 
such a degree that the spinal vertebrae may be felt through the 
abdominal walls. This we observe in persons who have been 
starving for a considerable time; also in cases of general maras- 
mus; in strictures of the oesophagus, the cardia, the pylorus, or 
the duodenum; after severe and long-continued diarrhoea and 
cholera; it is also a sign of painter's colic from poisoning with 
lead, and quite characteristic in brain diseases, especially tuber- 
cular meningitis. 

2. Its appearance in regard to motion. 

a. Respiratory motion. The diaphragm, moving up and down, 
makes, as we know, the abdomen participate in the respiratory 
motions of the chest. 



470 ABDOMEN. 

This respiratory motion of the abdomen is increased in such 
affections of the chest as prevent a normal extension of the 
thorax, as pneumonia, pleurisy, etc. 

It is decreased, or ceases altogether, in inflammation of the perito- 
neum, in large effusions of fluids or gas in the abdominal cavity, 
in consequence of large tumors which fill the abdomen, and also 
from injuries of the diaphragm. 

b. Pulsation. We observe it generally in the pit of the stomach, 
sometimes lower down, nearly to the umbilical region; rarely 
below the navel, and almost always in the medium line. 

This palpitation may have different causes: 

1. Abnormal position of the heart, its apex lying towards the pit 
of the stomach. In this case we hear, on auscultation, both ticks 
of the heart, or noises, if there are any, in the pit of the stomach, 
and not at the normal place below the nipple. 

2. It is caused by the right ventricle, which communicates its 
motion to the left lobe of the liver. In this case we hear also, on 
auscultation, both ticks of the heart at the pit of the stomach, 
and at the same time at the normal place. 

3. It is caused by the descending aorta, and the pulsation extends 
then further down towards the navel. In this case we hear, on 
auscultation, only one sound, or one noise, if there be any; this, 
however, appears a little later than the impulse of the heart at 
its normal place. 

The causes of this abdominal pulsation may be — 

a. Relaxed and thin abdominal walls; collapsed state of the 
abdomen. 

b. A curvature of the spine forwards, whereby the aorta comes 
nearer to the abdominal walls. 

c. A thickened left lobe of the liver. 

d. Increased impulse of the heart, as in hysteric individuals; 
or hypertrophy of the left ventricle in consequence of insufficiency 
of the aortic valves. 

3. Its appearance in regard to the elasticity of its external walls. 
We find it greatly relaxed, hanging down like a loose sack, in old 
women, or in those who have given birth to many children; also 
after absorption of large quantities of fluids, by which the ab- 
dominal parietes had been largely distended. 

A similar effect is produced by a large accumulation of fat 
within the subcutaneous cellular tissue. 

Large distention of the abdomen, especially pregnancies, some- 



ABDOMEN. 171 

times causes the straight muscles of the abdomen (the m. recti) to 
be driven asunder, so that a space of several inches occurs 
between them, which is very thin, consisting merely of the fasciae 
of the oblique muscles, the peritoneum, and the external cover- 
ing; whilst the recti muscles lie on the sides of the abdomen, 
forming there a pad-like protuberance. The thin, yielding- 
space in the middle between them, however, bulges out as soon 
as the person assumes a standing position, not being strong 
enough to keep the abdominal viscera in their normal position. 

4. Its appearance in regard to the development of its subcutaneous 
veins. We observe these veins largely distended whenever there 
exists an obstacle to the free circulation of the blood through the 
vena cava inferior. This may be caused by stricture or oblitera- 
tion of the vein itself, or by pressure of enlarged abdominal 
organs, or abdominal tumors upon it. Some of the blood which 
cannot pass there is brought by way of the venae intercostales, 
mammarise or axillares, from the lower portion of the body into 
the superior vena cava. 

The so-called Caput Medusse, which is a net-work of enlarged 
veins around the navel, arises from the umbilical vein, which 
has not become obliterated. 

5. Its appearance in regard to changes of color. Here I have to 
mention the straight line which we observe in pregnant women, 
extending from the navel to the symphisis pubis, either of a pale 
yellowish, brownish or even blackish color. This line has been 
observed quite exceptionally, however, in men, children and also 
such women as never had been pregnant. We sometimes observe 
also, whitish or bluish- white stripes like cicatrices on the sides 
of the abdomen, which are generally signs of previous pregnancy, 
as other distentions of the abdomen rarely cause them. 

On further examination of the abdomen by means of Palpa- 
tion, we may learn, first, the seat of the affection. 

a. If in the abdominal ivalls, we are able to raise the affected 
part during a relaxed state of the abdomen ; or, if the abdominal 
walls be put upon the stretch, we shall observe the swelling in it 
becoming more prominent. 

b. If the seat of the affection is in one of the abdominal organs, 
the swelling feels deeper and cannot be raised by lifting the re- 
laxed abdominal walls. In order to decide which organ is af- 
fected, we, of course, must be entirely familiar with the normal 
positions of these different organs. 



472 SPECIAL FORMS OF ABDOMINAL DISORDERS. 

Palpation teaches further the nature of the swollen parts in the ab- 
domen. 

A solid swelling we feel as such, whilst a fluid exudation gives 
to the examining hand the sense of fluctuation; provided the sac 
which contains it be not too much distended, in which case it feels 
as solid and hard as a stone, and without any fluctuation. 

Palpation is also important to become certain of the character 
of pain which the patient experiences on pressure. 

If the pain is increased by slight pressure and ameliorated by 
gradual deeper and deeper pressure, the affection is mostly of a 
nervous nature. When, however, the pain increases as the press- 
ure is increased, generally it indicates an inflammatory affection. 
Pressure upon the stomach frequently causes sickness and belch- 
ing; pressure upon the colon, desire for stool; and pressure upon 
the bladder, desire to urinate. 

Percussion gives a tympanitic tone whenever there is gas or air 
in the abdomen, unless the enclosed walls are too greatly dis- 
tended ; and an empty tone wherever there are solid bodies or fluid 
effusions in the abdomen. 

In this way we are enabled to determine the extent of the en- 
larged liver, spleen, hardened stomach, tumors and fluid effusions 
of the peritoneum or ovaries; also, the accumulation of gas in 
the stomach and intestines, or the peritoneal sac. 

Auscultation teaches very little, except what I have mentioned 
already, in regard to the visible pulsation of the abdomen. Foetal 
pulsations. 

a. SPECIAL FORMS OF ABDOMINAL DISORDERS. 

The organs in the abdominal cavity are many; each of them 
may be differently affected; consequently the special forms of ab- 
dominal affections must amount to quite a considerable number. 

I shall speak at first of the pathological conditions of tin stomach. 

Dyspepsia, Indigestion. 

. Dyspepsia means nothing more nor less than indigestion. If 
we consider for a moment all the causes by which indigestion 
may be brought about, we will comprehend at once the wide 
mouth and the big belly of that bag which is called dyspepsia. 
Still if, according to Pope, "One truth is clear, whatever is, is right," 



DYSPEPSIA, INDIGESTION. 473 

I shall not attempt to destroy this convenient bag, but shall 
merely endeavor to divide it, for a more intelligent use, into the 
following four departments: 

1. Dyspepsia may be caused by anatomical changes in the di- 
gestive apparatus, such as, catarrh, inflammation, thickening, 
ulceration, eruptions of the membranes of the stomach. 

2. Dyspepsia may be caused by quantitative or qualitative al- 
terations of the digestive secretions, such as, alteration of the 
gastric juice, of the juice of the pancreas, of the secretions of 
the liver and of the intestines. 

3. Dyspepsia may be caused by an abnormal condition of the 
nervous system, as we observe in consequence of mental excite- 
ments, of too great mental exertions, and all such influences as 
disturb the normal actions of the nervous system. 

4. And, lastly, dyspepsia may be caused by the use of irritating 
or stimulating food or drink; so that we find a whiskey-dyspepsia, 
a pepper-and-mustard-dyspepsia, a coffee-dyspepsia, and all sorts 
of other dyspepsias, among which we ought not to forget the ice- 
cream-dyspepsia and the sugar-dyspepsia. 

The symptoms of a disease which has so many different causes, 
must, of course, be variable, and I shall try to state only its most 
prominent features. 

Dyspepsia is characterized by — 

1. Want of appetite, or morbid appetite: craving for sour, acrid, 
spicy things, etc. 

2. Accumulation of wind in the stomach, and, in consequence of 
which, belching, oppression, palpitation of the heart. 

3. Formation of acids in the stomach, and, in consequence, sour, 
rancid eructations, pyrosis or heartburn, waterbrash. 

4. The food does not digest at all, causing vomiting or diarrhoea. 

5. The pit of the stomach is mostly sore to the touch; very 
sensitive to the pressure of clothes; it feels full, and is oftentimes 
swollen. 

G. The patient feels unfit for mental and bodily work; he is 
morose, irritable, sleeps badly; and, if asleep, his sleep is full of 
dreams. 

7. His face shows a relaxed, tired, weary, sad expression, with 
sunken, dull eyes; pale grayish or yellowish color and pale lips. 

8. His hands and feet are generally cold, and he is very sensi- 
tive to the cold. 

9. Gradual falling away in flesh and strength. 



474 STOMACH. 

THERAPEUTIC HINTS.— When we find,. in an acute disease, a 
patient strongly craving a particular thing to eat or drink, it is 
well and wise for the physician to satisfy this desire. In chronic 
cases, however, such as dyspepsia, which may have grown big by 
yielding to morbid desires, it is absolutely necessary to strictly 
forbid the use of all irritating nourishment, otherwise we feed 
the animal which we want to destroy. 

For special hints, compare Gastric Catarrh, acute and chronic; 
Liver Affections, Pancreatic troubles, etc. 

Vomiting-. 

A T omiting consists pathologically in an antiperistaltic contrac- 
tion of the stomach, and a spasmodic contraction of the dia- 
phragm and abdominal muscles, caused either by a direct influ- 
ence of the brain, or, which is much more frequently the case, an 
irritation of the nervus vagus, either in the stomach or in the 
pharynx, or by irradiation — {sympathetic). 

In cases of sudden and violent vomiting, especially if it hap- 
pens to otherwise healthy persons, we ought to think : 

Of poison: to ascertain which we must examine chemically 
what the patient throws up or what remains of what he partook. 
It may be arsenicum, corrosive sublimate, nitrate of silver, zincum, 
or stannum, tartarus emeticus, phosphorus, iodine, different kinds 
of acid, sulphuric, nitric, or muriatic, alkalies, as caustic potash, 
or vegetable or animal poisons. 

Of pregnancy: it sets in sometimes immediately after concep- 
tion, sometimes not before the first menstrual discharge should 
come on and does not. It lasts, in many cases, through the first 
half of pregnancy, in some longer, and in some it passes over 
quickly or does not set in at all. During parturition I have fre- 
quently observed vomiting shortly before the birth of the child. 

Of incarcerated hernia, intussusception, or invagination, which is 
generally attended with obstinate constipation. 

Vomiting from affections of the stomach may have its cause in a 
simple overloading of the stomach with indigestible food, or in 
catarrh of the mucous membrane of the stomach ; for example. 
in drunkards; or, in an ulcerated state of this membrane, in 
cancer of the stomach. 

Vomiting may also be caused by diseases of the peritoneum 
and intestinal canal; from affections of the liver, spleen, pan- 
creas, and urinary organs. 



ACUTE CATARRH OF THE STOMACH, GASTRITIS. 475 

Sometimes it may be merely the affect of the mechanical con- 
cussion during hard coughing, laughing, etc. 

Vomiting from affections of the brain is found in consequence 
of external injuries of the head and concussion of the brain ; 
may be caused by strong impressions upon the sensorial and 
sensitive nerves; the swinging motion of a ship, seasickness, etc.; 
is found in hyperemia and anaemia of the membranes of the 
brain; in inflammation of the brain and its membranes; in dif- 
ferent organic diseases of the brain ; in megrim and sick head- 
ache. 

THERAPEUTIC HINTS.— If vomiting be caused by poison, the 
poison should be removed or neutralized as soon as possible. 
The stomach-pump is often greatly preferable to emetics. 

The antidotes of the different poisons may be found in the 
Materia Medica, and they are well arranged in Dr. Hering's 
" Domestic Physician." 

If it be caused by an incarcerated hernia, the hernial sac should 
be put back by taxis or surgical operation. Compare : 

Aeon., Nux vom., Sulphur, Lycop., Opium, Plumbum. 

For vomiting in pregnancy, Nux vom., Veratr., and many 
others. 

For all other kinds of vomiting we must select the remedy in 
accordance with the indications in each individual case, and its 
underlying cause. 

Acute Catarrh of the Stomach, Gastritis. 

Pathologically gastritis is similar to a catarrhal inflammation 
of any other mucous membrane. We observe redness and velvet- 
like swelling of the mucous membrane, which is oftentimes cov- 
ered with a tough, transparent, or whitish-gray slime. In severe 
cases the mucous membrane appears softened that it may easily 
be scraped off like a mushy covering ; but this change may be 
the result of self-digestion after death, due to the specific contents 
of the stomach. (Compare Softening of the Stomach.) 

Primarily, catarrh may be caused by taking cold or getting 
wet, like any other catarrh ; but principally it is caused by 
either too cold or too hot food or drink ; or certain kinds of food, 
like too fat or old meat and fish, pork, sausages, cheese, alcoholic 
drinks, ice-cream, ice-water; iced milk is still worse than ice- 
water. 



476 STOMACH. 

Starvation is not less a cause of it. Also mental exertions 
and excitement, fright, grief, worriment and the like, may 
cause it. 

•Secondarily, we find it in combination with the perforating 
round ulcer of the stomach; cancer of the stomach; as a contin- 
uation of inflammation of the fauces and the cesophagus; inflam- 
mation of the intestines ; or as a concomitant of typhus, pneu- 
monia, exanthematic fevers and erysipelas. 

The heat of the summer is most favorable for its development; 
no doubt on account of the free use of ice water in a heated 
stomach ; but it also frequently occurs in spring and fall. 

Symptoms. — The patient gets morose ; feels weak and chilly, 
with paleness of the face and cool extremities. The chilliness 
alternates with flushes of heat, red face, and febrile motions. 
The pit of the stomach feels full, and sore to the touch, so that 
even the pressure of garments feels uncomfortable. The appetite 
is gone; thirst, however, is generally present. At the same time 
the patient feels nauseated ; frequently gulps up a sour or flat- 
tasting fluid ; and generation of gas in the stomach swells the 
region of the stomach and causes belching of wind. In the 
cases in which the catarrhal affection extends into the bowels, it 
causes rumbling flatulency, escape of fetid flatus, and mushy, 
fetid discharges. At the commencement of the disease the bowels 
are mostly constipated, and the urine is dark-colored. Toward 
the close we frequently observe the formation of herpes labialis 
or hidroa. 

In some cases gastritis is attended with a higher or less degree 
of fever, and then it goes under the name of Gastric fever. The 
fever generally augments in the first days, shows evening exacer- 
bations, and may last from one to two weeks, when the patients 
gradually recover. 

In other cases, which generally are characterized by gnat 
obstinacy, there is an abundant secretion of tough mucus, not 
only throughout the alimentary canal, but also in the bronchial 
tubes and the urinary organs. This form is known under the 
name of Febris mucosa. The patients become greatly exhausted 
and apathic, and after a slow recovery are very liable to re- 
lapses. 

Still another form is the so-called Bilious fever, when the gas- 
tric catarrh is complicated with an abundant secretion of bile. 
Here the pulse is much more frequent and the temperature much 



ACUTE CATARRH OF THE STOMACH, GASTRITIS. 477 

higher than in an ordinary gastric fever; there is vomiting of 
bitter and green masses; the liver is somewhat swollen, and a 
light icteroid coloring of the white of the eyes may appear, until 
finally after a weeks duration, the whole train of symptoms is 
wound up with a bilious diarrhoea. In the first days it is often 
difficult to discern between these forms of gastric catarrh and 
Typhoid fever. However, gastric fever is generally preceded by 
dietetic faults; its temperature ranges never very high, nor does 
it show the characteristic step-like increase of a typhoid fever 
temperature, and the fever blisters around the mouth, a frequent 
occurrence in gastric catarrh, are extremely seldom met with in 
typhoid fever. 

THERAPEUTIC HINTS.— Aeon., after taking cold; stitch-like, 
burning, and pressing pain in the pit of stomach, with anguish 
and fear of death ; fever with great thirst and vomiting. 

Ant. erud., total loss of appetite; tongue thickly coated, yellow 
or white; great thirst at night; nausea; belching, with taste of 
what had been eaten; vomiting; after bad, sour wine; after 
bathing. 

Apis, painful sensitiveness in the pit of the stomach, with 
burning; painless, yellow diarrhoea. 

Arnica, after a blow or fall; sense of fulness in the pit of the 
stomach; belching, with taste of putrid eggs; hot head, remain- 
der of body cool. 

Arsen., nausea and vomiting, worse from rising up ; quick pros- 
tration; anxious restlessness; great thirst, but drinking little at 
a time; after abuse of ice, ice-water, ice-cream, vinegar, sour 
beer, tobacco (chewing), alcoholic drinks. 

Bellad., cutting pain in the stomach, worse from motion and 
pressure; vomiting; gagging; hiccoughing; great thirst, but 
drinking makes it worse, consequently the patient abstains from 
drinking. 

•Bryon., stitching pain in the region of the stomach, worse from 
motion, and especially from a misstep; tongue coated; dry with- 
out thirst; or else great thirst day and night, and drinking large 
quantities; constipation. In warm weather, and after eating of 
flatulent food. 

Carb. veg., great deal of belching, sour and rancid; burning in 
the stomach; bloatedness of the abdomen; disgust for meat; de- 
sire for acids ; after debauching. 



478 STOMACH. 

Chamom., bitter taste in the mouth ; vomiting of bile or green 
mucus; belching; rumbling in the bowels; hot and red face; 
much excited, as if beside himself; sleeplessness; after offence, 
vexation, anger. 

China, feeling satiated all the time; however, when trying to 
eat, he can eat something, but feels bad afterwards, and cannot 
say how; fulness in the stomach and bowels; belching; sour ris- 
ing; cold feeling in the stomach; great lassitude and weakness. 

Euphorb. cor., sudden nausea, vomiting and diarrhoea of watery 
fluid, with sinking, anxious feeling of the stomach; faintness; 
slow and weak pulse; cool skin; cool hands and feet, which 
become affected with cramps. 

Hydrast, dull, aching pain in the stomach, which causes a very 
weak faintish feeling, "goneness" in the epigastric region; acidity ; 
constipation. "After drugging." (W. Goodno.) 

Ipec, constant nausea proceeding from the stomach, with empt}' 
eructations and accumulation of much saliva; easy vomiting; 
diarrhoea; after eating sour, acrid things; sour, unripe fruit, 
berries, salads, etc. 

Iris ver., great burning distress in the epigastric region ; vomit- 
ing with diarrhoea, accompanied with great prostration; burning 
in the mouth, fauces and oesophagus; and headache. 

Kali carb., emptiness and gone feeling in pit of stomach; after 
eating, fulness, heaviness and pressure in pit of stomach; vomit- 
ing; dry stool; turbid urine; constantly chilly. 

Nux voxn., always after the use of tinctures, mixtures, tonics, 
vegetable pills, coffee, wine, condiments; after mental overexer- 
tions ; in leading a sedentary life ; bitter or sour taste ; sour 
belching; fulness and pressure in the stomach; constipated 
bowels; dizziness, headache; irritable, cross; all worse in the 
morning, in the open air and alter eating. 

Podopli., food turns sour after eating; belching of hot flatus, 
which is very sour; great thirst; vomiting; the stomach contracts 
so hard and rapidly in the efforts to vomit that the wrenching 
pain causes the patient to utter sharp screams; vomiting of bil- 
ious matter, mixed with blood. 

Pulsai, no appetite; no thirst; bitter taste in the mouth; every- 
thing tastes bitter ; dizziness when rising from a chair; chilliness; 
after fatty substances — pork, pastry, rancid butter, etc. 

Rumex, shootings from the pit of the stomach into the chest in 
various directions; aching pain in the pit of the stomach, and 



CHRONIC CATARRH OF THE STOMACH. 479 

aching and shooting above it in the chest; fulness and pressure 
in the pit of the stomach, extending towards the throatpit; it 
descends towards the stomach upon every empty deglutition, but 
immediately returns; flatulence; eructations; pressure and dis- 
tention in the stomach after meals. 

Sanguin., nausea, with headache, chill and heat; vomiting, with 
severe painful burning in the stomach, and intense thirst ; red 
tongue ; red and dry lips ; hot and dry throat ; tickling cough. 

Sepia, sensitiveness of the pit of the stomach to touch; bloated- 
ness of the abdomen ; congestion and heat of the head ; headache ; 
tongue coated without lustre; often sore and covered with little 
blisters on the edges and tip ; sour smell from the mouth, and 
likewise of the urine, which is clear like water, or pale-yellowish ; 
constant drowsiness; anxious dreams, and great fever heat; espe- 
cially in children, from taking cold when the weather changes. 

Chronic Catarrh of the Stomach 

Is, in many cases, only a continuation of an ill-managed, acute 
attack, but it may grow out of too free a use of spirituous liquors, 
coffee, chewing and smoking of tobacco ; it may have its origin 
in gluttony, sedentary habits, mental exertions, long-continued 
mental emotions, etc. 

Secondarily, it has been observed accompanying heart, liver, 
lung and pleura affections ; anaemia, chlorosis, Bright's disease, 
marasmus, tuberculosis, gout, cancer, haemorrhoids. 

Its most permanent symptoms are, indigestion or dyspepsia, 
belching after eating, mostly sour, and attended with heartburn; 
pressure and full feeling in the epigadric region, with actual distention 
of the same. 

Other symptoms are, nausea and vomiting, loss of appetite, or 
perverted appetite, or ravenous hunger, with gaping and faint- 
ness ; after eating always pain in the stomach. Such patients 
feel weak ; they are morose, irritttble and quite sleepy through 
the day. By-and-by their skin becomes pale and dry, and they 
become emaciated. 

Its progress is a slow one, and whether curable or not curable, 
depends entirely upon its combination with other diseases. 

On the authority of Kafka I shall give the following therapeutic 
remarks : 

Aching or burning pain in the pit of the stomach : increased from 



480 STOMACH. 

palpation or pressure of the clothes ; and distention of the epigastric 
region, Bellad., Phosphor., Arnica, Arsen. 

Aching in the pit of the stomach, not much increased by external 
pressure, Bellad., Phosphor., Hepar, Ignat., Nux vom., Arnica, 
Calcar., Zincum. 

Aching in the pit of the stomach, not increased by external press- 
ure, Carb. veg., China, Chin, sulph., Capsic, Natr. mur., Lycop., 
Sulphur. 

Sour stomach, with sour belching and taste; heartburn; gulping up 
and vomiting of sour matter, Nux vom., Calc. carb., China, Phosphor., 
Sulphur, Kali carb., Carb. veg. 

Sour stomach always after eating, Nux vom., Kali carb., Natr. 
mur., Sulphur, Phosphor., Sepia. 

Rancid belching, Pulsat, Carb. veg., Magn. mur., Sulphur., Asaf. 

Foul belching, Sepia, Phosphor., Arsen., Arnica, China, Ferr ac, 
Mercur. 

Much mucus in mouth and stomach, Pulsat., Amm. mur., Natr. 
mur., Arnica, Sulphur. 

Accumulation of bile in the stomach, with hitter taste, bitter belching, 
and vomiting, Chamom., Pulsat., Arsen., Ipec, Nux vom., Yeratr. 

Much wind in the stomach, with distention, Nux vom., Carb. veg., 
Ignat., Arnica, Sulphur, Arsen., Phosphor. 

Distention of the abdomen, Carb. veg., Nux vom., China, Arnica, 
Natr. mur., Phosphor., Sepia. 

Relief from eructations, Laches., Carb. veg., Ignat.. Lycop., Tart, 
emet., Nux vom., Sulphur. 

Relief from wind passing down, Nux vom.. Carb. veg., Pulsat., 
China, Chamom., Lycop. 

Worse from accumulation of flatulence, Nux vom., Carl.), veg., 
Pulsat., Ignat., Natr. mur., Phosphor., Arnica, China, Chamom., 
Kali carb., Coloc. 

Slow digestion, Nux vom., Ignat., Phosphor., China, Opium. 

Total loss of appetite, Nux vom., China, Sepia. Natr. mur., Arsen. 

Feeling of emptiness and hunger in the stomach without desire for 
food, Natr. mur., Opium, Arsen. 

Ravenous hunger, Nux vom., Calc. carb., China, Iodium, Natr. 
mur., Phosphor. 

Worse after eating, Nux vom., Calc, carb., Phosphor., Natr. mur., 
Sepia, Sulphur. 

Disgust against meat, Sulphur, Sepia, Petrol., Mur. ac, Natr. 
mur., Carb. veg., Arsen. 



GASTRITIS TOXICA SEU CAUSTICA. 481 

Sleepiness in the daytime, Natr. mur., Pulsat., Sepia, Calc. carb., 
Carb. veg., Chinin., Kali carb. 

Great weakness and loss of energy, China, Chin, sulph., Arsen., 
Phosphor., Iodium, Ferr. ac. 

Gastritis Toxica seu Caustica, Inflammation of the 
Stomach in consequence of Poisoning. 

Such poisoning is caused by concentrated or diluted mineral 
acids, caustic alkalies, salts and metals, acrid, vegetable, or ani- 
mal poisons, and ethereal oils. 

Diluted mineral acids change the epithelium and the superfi- 
cial layers of the mucous membrane of the stomach into a soft, 
brownish, even blackish mass. Concentrated mineral acids change 
all layers of the mucous membrane into a blackish mass; the other 
coats of the stomach become softened, and, in some rare cases, per- 
forated — eaten through. The blood in the vessels of the stomach 
and in the adjoining larger vessels is black and tough, like tar. 
Caustic alkalies — for example, the kali causticum or ammonium 
causticum — change the epithelium and the mucous membrane of 
the stomach to a pappy, discolored mass; they destroy and perfo- 
rate the coats of the stomach much more readily than acids do. 

Salts of metals, like verdigris, corrosive sublimate, argentum 
nitricum, tartarus emeticus, likewise arsenicum and phosphorus, 
cause brown scurfs, surrounded by injected and swelled portions 
of the mucous membrane of the stomach. Acrid, vegetable and 
animal poisons, and ethereal oils cause a highly inflamed state of 
the mucous membrane of the stomach. 

Poisoning is characterized by the following symptoms: violent 
pain in the stomach and bowels ; vomiting of slimy or bloody 
masses ; slimy, diarrhceic discharges from the bowels, mixed with 
blood ; and tenesmus ; the features of the face become distorted ; 
there is sudden loss of strength ; coldness of the extremities ; 
and cold, clammy perspiration ; the pulse is small and thread- 
like. 

If the patient informs us what he has swallowed, our diagnosis 
is safe enough. If not, the ejected masses will have to be ex- 
amined. Mineral acids and caustic alkalies leave their traces 
also upon the mucous membrane of the mouth and fauces. 

THERAPEUTIC HINTS.— If we see a case soon after the swallow- 

31 



482 STOMACH. 

ing of poison, this poison must be either removed or neutralized 
— acids by alkalies and alkalies by acids. 

Chronic consequences require: after acids, Calc. carb. ; after 
alkalies, Nitr. ac. ; after ethereal oils, Nux vom., Arsen. ; after 
metals, Hepar. 



Gastralgia, Cardialgia Nervosa, Cramp of the Stomach. 

This affection is characterized by attacks of great pain in the 
stomach, which come at intervals, leaving the patient free from 
pain between the attacks ; there is no structural change of the 
stomach effected by it. We frequently find this complaint, how- 
ever, in connection with anaemia, chlorosis, tuberculosis, or great 
loss of vital fluids; also with chronic catarrhal affections of the 
stomach, the round perforating ulcer, and cancer of the stomach; 
also with diseases of the womb, as falling or dislocation of the 
womb ; catarrh or ulceration of the mouth of the womb ; too 
scanty or too profuse menstruation ; also, with diseases of the 
spine, especially such forms as present an intermittent character ; 
and finally we observe it frequently in consequence of depressing 
mental emotions; chilling the stomach by drinking ice-water or 
eating ice-cream while being heated ; or after the use of lemon- 
juice, or other acid fruits, coffee, fresh bread, and hot cakes, and 
other things which are difficult to digest. 

The attack usually commences with a feeling of pressure in 
the pit of the stomach, frequent yawning, coldness of the extrem- 
ities, and an uncomfortable feeling in the middle of the spine, 
which induces the patient to bend backwards frequently. Some- 
times, without such premonitory signs, a violent pain in the 
stomach sets in at once, which may be various in character — 
pressing, drawing, burning, boring, gnawing, cramp-like, etc., 
amounting sometimes, to such a degree of severity that the 
patient faints away; his face appears collapsed, his extremities 
become cold, and his pulse small and thready. The pain seems 
to radiate from the spine and reflect upon the chest, where it 
causes asthmatic symptoms; or, it reflects upon the (esophagus, 
causing the so-called globus hystericus; or, upon the larynx, 
causing choking; or, upon the sympatheticus. causing spasmodic 
laughing and crying; or, upon the nerves of the cranium, caus- 
ing hemicrania; or, upon the intestines, causing pain in the 
bowels and diarrhoea. The pain is oftentimes relieved by hard 



GASTRALGIA, CARDIALGIA NERVOSA. 483 

pressure upon the stomach, but sometimes the patient cannot 
even bear the pressure of the clothing. The pit of the stomach 
is, in some cases, distended, in others it is drawn in; often we 
observe a pulsation in the epigastrium. 

The attack generally ends with belching of wind, vomiting of 
watery, sour fluids, passing of watery urine, and with a gentle 
perspiration. In some cases there is a great accumulation of 
wind in the stomach, so that the pit of the stomach and the 
bowels are greatly distended, with constant belching and rum- 
bling in the bowels. Belching and passing wind generally 
brings relief. 

THERAPEUTIC HINTS.— Abies nigra, continual distressing con- 
striction just above the pit of stomach, as if everything was knot- 
ted up, or as if a hard lump of undigested food remained there. 

Abroi, feeling as if the stomach were hanging or swimming in 
water, with a sense of coldness. Pains cutting, gnawing, burn- 
ing, contracting, stinging, mostly worse at night. Never entirely 
free from pain. 

Arg. nitr., in the middle between the xyphoid cartilage and the 
navel a small spot, which is very sensitive to the slightest press- 
ure; from this spot a very severe pain spreads to the hypochon- 
driac region, into the back, up into the shoulders, even to the 
head ; gradually increasing in intensity, and as gradually leav- 
ing again. 

Arsen., burning pain, as of red-hot coal ; pit of stomach sensi- 
tive to slightest touch ; vomiting of ingesta as soon as taken ; 
anguish ; restlessness ; dyspnoea ; fainting ; pale, earthy face ; 
worse from eating and touching; better from w T arm applications; 
brought on by eating ice-cream or drinking ice-water. 

Asaf., pressing, cutting, stitching pain in spells ; eructations of 
a smell like garlic or feces ; accumulation of gas ; constantly 
pressing upwards, none downward ; gulping up of rancid, acrid 
fluids ; obstinate constipation. Pain in paroxysms ; better from 
eating ; worse when stomach is empty. 

Bellad., gnawing, pressing, crampy, drawing, wrenching pain, 
which compels the patient to bend backwards, and to hold his 
breath ; pain extending through to the spine, with tired feeling 
in the spine; great thirst, but feels worse after drinking; face 
hot, red, bloated; pupils enlarged; especially for the female sex, 
when the menstrual period has been disturbed. 



484 STOMACH. 

Bismuth., sense of heaviness like a weight in stomach ; intense 
pressure in a defined spot with pain in the spine, compelling the 
patient to bend backwards. 

Bryon., pressing pain, as of a stone or a load in the stomach; 
worse from eating or drinking; from any motion; better when 
lying quiet on the back. 

Calc. carb., pressing pain, as of a load or stone in the stomach ; 
or from the abdomen rising up into the throat; sour belching 
and vomiting; better from motion; too profuse catamenia. 

Calc. hypophosph,, sudden appearance of the attacks; absence of 
gastric catarrh ; entirely free at intervals ; sensation as if the pain 
and distress were caused by wind ; spreading of the pain upwards, 
never downwards. Attacks appear suddenly two hours after 
each regular meal, and are appeased by taking a cup of milk or 
other food carefully chewed. Without this the pain steadily in- 
creases, extends to the spine, into the chest and throat, and is ac- 
companied by a rising of clear, white, brackish, sour froth, and a 
gnawing in the stomach. (F. G. Oehme.) 

Carb. veg., after Nux vom., burning pain, extending down to 
the small of the back and up to the shoulders; sour, rancid belch- 
ing; cold limbs; cold sweat; worse from lying down; after rich 
living; drinking of spirituous liquors. 

Chamom., when sitting or standing the pain doubles him up; 
in bed he tosses about in great agony ; hands and feet cold ; after 
anger or vexation. 

Chelid., gnawing, grinding pain, ameliorated by constantly eat- 
ing something. 

Coloc, violent cutting, tearing pains which, from different parts 
of the chest and abdomen, concentrate in the pit of the stomach; 
relieved by hard pressure and bending double; after vexation 
and indignation. 

Ferrum, pressure in the stomach ; vomiting of ingesta, and bet- 
ter afterwards; worse after drinking milk; chlorotic and anaemic 
individuals. 

Gelsem., sensation of a heavy load with weight; tension and 
dull pain ; sometimes with empty, faint sensations in the epigas- 
trium, and a false hunger — a kind of gnawing. 

Grapnit, anaemic, chlorotic patients. Dysmenorrhea ; constant 
yawning and bloatedness of the stomach. 

Ignat, gnawing, cutting pain in the stomach; faint feeling; 
false hunger; collection of w r ater in the mouth; nausea and vom- 



GASTRALGIA, CARDIALGIA NERVOSA. 485 

iting of mucus; poor digestion; bloated stomach; pale, watery, 
profuse urine; after grief or poor living; habitual smoking. 

Leptand., sharp, cutting pains at intervals in the lower part of 
the epigastrium; constant aching distress; worse from drinking 
cold water; after rising; great desire for stool, that cannot be re- 
tained one moment. 

Lycop., brought on by eating fruit; flatulency; flowing saliva; 
constipation ; pain better from bending. 

Nux vom., pressing, constricting, clawing pain in the pit of the 
stomach, extending into the chest, or towards the small of the 
back and to the anus, which is drawn in ; worse after eating and 
drinking; better from belching, after vomiting, from bending 
forward and rubbing the pit of the stomach ; great irritability ; 
headache; loss of appetite; or hunger, with fear of eating; 
belching, vomiting, and gulping up of sour substances; consti- 
pation ; haemorrhoids ; suppressed menstruation ; complaints from 
the use of coffee or liquors ; sedentary life ; night-watchings; an- 
ger and worriment; always after previous use of nostrums. 

Petrol., pressing, drawing pain, ameliorated by constantly eat- 
ing something. Compare Chelid. 

Phosphor., a singular rising of the swallowed food by mouth- 
fuls; gnawing pain; worse from motion; pain worse after eat- 
ing; during the presence of morbid hunger eating relieves for a 
short time; decidedly better when keeping warm in bed. 

Phosph. ac, violent pressure in pit of stomach through to the 
back; worse from touch. Urine white and almost as thick as 
milk. 

Plumbum, the patient bends backwards during the spell; gets 
better from hard external pressure upon the stomach; after- 
wards yellow appearance of the white of the eyes; badly-smell- 
ing sweat of the feet; during paroxysm, abdomen hard like a 
board; pharynx feels constricted; hands and feet cold. 

Pulsat, dizziness when rising ; loss of appetite ; no thirst ; sour 
or bitter vomiting; after eating fat meat, cakes, pastry, and drink- 
ing whiskey ; the attacks are worse in the evening. 

Piumex, "shootings from the pit of the stomach into the chest 
in various directions; aching pain in pit of stomach, and aching 
and shooting above it in the chest; fulness and pressure in pit 
of stomach, extending toward the throatpit; it descends toward 
the stomach with every empty deglutition, but immediately re- 
turns. Pressure and distention of stomach after eating; stitch- 



486 STOMACH. 

ing, cutting pain in pit of stomach; worse on movement." (W. 
K. Knowles.) 

Staphis., after indignation. 

Sulphur, pain in right hypochondrium extends over stomach 
to left; cannot lie on either side; when lying on back the pain 
spreads to chest under sternum and hinders respiration; must 
get up and walk about. 

Ver. alb., pains radiate to back and shoulders; increase slowly 
and decrease slowly, and are attended with a shaking chill, and 
cold hands and feet. 



Ulcus Ventriculi Perforans (rotundum, chronicum), the 
Round Perforating Ulcer of the Stomach. 

In four-fifths of the cases the ulcer is situated upon a region 
bounded by the posterior wall, the lesser curvature and the py- 
loric region; the rest of the surface of the stomach appears to be 
affected in only one-fifth of the cases; it was also frequently ob- 
served in the duodenum, in cases of Chickahominy diarrhoea. 
Only one ulcer is usually found; exceptionally there are two. 
three, or more. Its size varies: it may be smaller and also much 
larger than a three-cent silver piece; its shape is round, some- 
times oval; and in case.'? where several ulcers join, it is irregular. 
On the inside of the stomach it is largest, and grows smaller in 
its progress of eating through the different layers of the stom- 
ach, so that it assumes a funnel-shaped appearance. When it 
reaches the serous membrane of the stomach it causes peritoneal 
inflammation and fibrinous exudation, which cause adhesions 
with the adjoining organs, as the pancreas, liver, omentum and 
colon. When even this last or external membrane is eaten 
through, it causes peritonitis. 

This ulcer may heal in any of its different stages, in which 
event new granulations are formed, and the whole is shut by a 
flat, radiated cicatrix, in consequence of which it sometimes hap- 
pens that the pylorus becomes constricted, so that the exit of the 
food into the intestines is impeded. Such a cicatrized indura- 
tion of the pylorus can generally be detected by palpation in the 
pit of the stomach as a hard swelling. 

In regard to its origin we are quite in the dark. Rokitansky 
considers as the next cause hemorrhagic erosions. They consist, 
according to Virchow, in obstructions of arterial vessels, in con- 



ULCUS VEXTRICULI PERFORANS. 487 

sequence of which the mucous membrane becomes deprived of 
its necessary nutriment and dies off, and by the corroding effects 
of the acids of the stomach is eaten out deeper and deeper. Of 
special interest is its occurrence after extensive burns of the skin and 
its coincidence with trichinosis. 

The Symptoms are as follows: pain, exactly as in gastralgia, 
in the pit of the stomach, often extending to the spine, coming in 
spells mostly after eating, ameliorated, sometimes ceasing, after 
vomiting of slimy, tough or watery, clear, tasteless or sour fluid, 
often containing blackish or brownish flakes. 

Vomiting is found not only during the cardialgic spells, but, 
also between these spells, although in exceptional cases it is not 
a prominent symptom. It generally happens soon after eating 
and frequently without previous nausea, and without great exer- 
tion. Acrid, sour, indigestible food causes it most frequently. 
The vomit often contains particles of decomposed blood in the 
form of blackish or brownish flakes and masses, and sometimes 
even clear blood in large quantities. But even this bloody vomit 
is not a constant symptom ; in cases of slow bleeding the blood 
may pass into the intestines and be carried off in the form of 
tarry faeces. 

Indigestion. In some cases the appetite is little or not at all 
changed, but in severer cases it is diminished, or altogether ab- 
sent. Eating usually causes pain and digestion is very slow. 
Milk and white meat are best digested. Eructations, nausea, 
pyrosis or waterbrash, are symptoms of the chronic catarrh at- 
tending the disease; and obstinate constipation is of frequent 
occurrence. Sooner or later, the face of the patient assumes a 
pale, sallow aspect, his spirits become depressed, he loses flesh, 
and grows weaker and weaker. 

When perforation takes place, which may happen either spon- 
taneously or in consequence of a strong concussion of the body, 
or from overloading the stomach, or during a hard attack of 
vomiting, we have in a very short time all the symptoms of a 
peritonitis. The patient experiences a stitch-like or cutting pain, 
altogether different from that of a cardialgic spell ; he is seized 
with a violent chill and vomiting, and his features become col- 
lapsed, distorted, pale, expressing deep pain and agony. The ab- 
domen distends largely and is very painful, especially when 
touched. Respiration is short, superficial, without any respira- 
tory motion of the diaphragm. There is singultus ; violent ac- 



488 STOMACH. 

tion of the heart; frequent, small pulse; fainting; decrease of 
natural temperature ; great prostration and collapse. 

Some chronic cases take to the end a latent course, until at last 
discovered as cicatrices on post-mortem examination. This surely 
proves the curability of this disease. The disposition to it seems 
to be greater during middle life, and is by no means of rare 
occurrence. 

Differential Diagnosis. — It may be confounded with chronic 
catarrh of the stomach. The round ulcer, however, generally shows 
a clean, red tongue, has much more frequent vomiting; and the 
vomit is often tinged with either fresh or decomposed blood, and 
the soreness in the epigastrium is confined to a circumscribed 
spot with frequent cardialgic spells. 

It may be confounded with cardialgia. The round ulcer, how- 
ever, has a falling away of flesh and change in features, pale, 
yellowish face, and vomiting between the cardialgic spells, which 
we do not observe in gastralgia. 

It may be confounded with cancer of the stomach ; cancer, how- 
ever, comes at a later period of life; its pain in the stomach) 
although often severe, never extends to the spine; it tells much 
quicker upon the general constitution by the wasting away in 
flesh ; it is often marked by a hard swelling in the pit of the 
stomach, which is observed in cases of round ulcers, only when 
the pylorus becomes cicatrized ; it commences with feverish at- 
tacks and ends with a cachectic fever. 

THERAPEUTIC HINTS.— Milk and mutton or beef-broth must 
he considered as the best diet. 

Arg. nitr., pain below the xyphoid process in a small place ex- 
tending to a corresponding point in spine, where pressure aggra- 
vates it. 

Arsen., vomiting of black, decomposed blood; burning pain; 
always worse after eating or drinking; gray-yellowish color of 
the face. Chlorotic patients, with anaemic murmur in the large 
blood-vessels and scanty menses. 

Atropin., pressing pain after eating; and vomiting of acrid, sour 
masses which set the teeth on edge; hard swelling in the region 
of the pylorus, just above the navel towards the right, very sen- 
sitive to touch ; excruciating pain in the stomach ; constant 
vomiting; deadly paleness of the face, with cold perspiration; 
hands and feet icy cold ; pulse very small. Peritonitis in conse- 
quence of perforation of the stomach. Compare BeUad. 



ULCUS VENTRICULI PERFORANS. 489 

Carb. veg., gray, yellowish face; dry tongue; vomiting of sour, 
bilious or bloody masses ; burning in the stomach ; worse after 
eating; better from drinking cold water ; eructations; distortion 
of stomach and bowels ; costiveness. 

Conium, Coniin., vomiting of black masses like coffee-grounds in 
clear, sour water; violent pain in the stomach, always two or 
three hours after eating, but also at night ; somewhat relieved in 
the knee-elbow-position ; swelling in the region of the pylorus. 

Ferrum, in anaemic and chlorotic patients, with murmurs in the 
large blood-vessels and scanty menses. Haemorrhage from stom- 
ach and pain in stomach through to the spine. 

Kali bichr., ulcers are oval ; they corrode and become deeper 
without spreading in circumference; pressure and heaviness in 
the stomach after eating ; giddiness, followed by violent vomit- 
ing of a white, mucous, acid fluid, with pressure and burning in 
the stomach ; vomiting of sour, undigested food ; of bile, with 
pinkish, glairy fluid ; of blood, with cold perspiration on the 
hands; burning in the stomach; heat of the face; all of which 
symptoms decidedly suggest its application in the round, perfo- 
rating ulcer of the stomach. 

Lycop., earthy color of the face; rising of sour, acrid fluid; 
vomiting of sour water and mucus; fulness of stomach and abdo- 
men; pain in the stomach after eating; rumbling and gurgling 
in the abdomen; constipation; scanty urine; worse from sitting 
bent; better from rising and walking about; no pain at night, 
when warm in bed. 

Mezer., constant, violent pain and pressure in the stomach after 
eating, no matter what, even simple things like broth, milk, 
bread ; a constrictive squeezing pain with much belching from 
one to two hours after eating ; the pain reaches its height and 
ends with vomiting and gulping up what has been eaten ; con- 
stipation ; circumscribed redness of the face; skin cool, pulse very 
small and frequent ; chilliness alternating with flushes of heat. 

Nux vom., frequently indicated at first when the patient already 
has been drugged. Yomiting in the morning before breakfast. 

Phosphor., regurgitation of food by the mouthful without nau- 
sea ; regurgitation of cold drinks as soon as it has become warm 
in the stomach. Excessive acidity ; flatulency ;, constipation. 

Sepia, yellow bridge over the nose ; earthy complexion ; sour 
taste in the mouth after eating; vomiting of mucus; pain in the 
stomach after eating the simplest kind of food ; hardness in the 



490 STOMACH. 

region of the pylorus ; constipation ; stitching all over the body, 
with breaking forth of little pustules ; menses scanty. 

Silic, yellowish complexion ; screwing, pressing, twisting pain 
after drinking ; pyrosis and vomiting after eating. 

Sulphur, constant pain in stomach and back after suppressed 
itcb ; sour taste in the mouth and sour vomiting ; constipation ; 
piles ; cold legs. 

Compare also Gastralgia and Hsematemesis. 

Carcinoma or Scirrhus Ventriculi, Cancer of the Stomach. 

According to pathological researches there are three different 
forms of cancer of the stomach : 1. Scirrhus a fibrous growth in 
which the connective tissue stroma predominates over the crude 
bodies, generally originates in the submucous cellular tissue ; 
2. Carcinoma medullaris, a marrow-like growth, in which the can- 
cer-cells predominate over the stroma, forms round isolated lumps 
in the mucous membrane of the stomach, and spreads sponge- 
like upon the inner surface of the stomach ; and 3. Carcinoma 
alveolaris, a jelly-like growth, in which we observe a colloid de- 
generation of the cancer-cells, invests at first the submucous 
cellular tissue, but penetrates frequently to the peritoneum, and 
forms large tumors upon it. All three kinds of cancer may often 
be seen together; and they mostly invest the pylorus, sometimes 
the lesser curvature, still rarer the cardia, and most rarely other 
parts of the stomach. 

It is often the case, that the diseased pylorus forms adhesions 
with adjoining organs, such as the pancreas, liver, kidneys and 
colon, which are mostly invested by the same morbid product, 
keeping the stomach in a fixed position. When, however, such 
adhesions do not take place, the stom ich sinks, in consequence 
of its increased weight, lower down into the abdominal cavity ; 
remaining there, either perfectly free and movable, or adhering 
to organs lower down such as portions of the intestines, the 
uterus, or its appendages. 

The inner cavity of the stomach is much changed by this 
disease. It becomes greatly enlarged by stricture of the pylorus, 
much diminished by stricture of the cardia, and cancerous de- 
generation of the coatings of the stomach. The mucous mem- 
brane, in the neighborhood of the cancer, exhibits chronic 
catarrhal inflammation, which is sometimes spread all over it ; 



CARCINOMA OR SCIRRHUS VENTRICULI. 491 

and, in the further progress of the disease, ulceration and arrosion 
of smaller or larger hlood-vessels with consecutive haemorrhage 
obtain. 

The causes of carcinoma of the stomach we do not know, just 
as little as the causes of cancer in any other part of the body ; 
heredity seems to deserve some amount of consideration. The 
disease has been observed most frequently between the years of 
fifty and seventy. 

Symptoms. — 1. General cancer-cachexia : emaciation; paleness 
of the skin and the mucous membranes ; ash-colored or yellowish 
color of the face ; brittle, dry, harsh and wrinkled skin ; peeling 
off of brany scales, especially from the lower extremities. The 
expression of the face is sad ; the eyes are fallen in ; the malar 
bones stick 1 out; the ankles are cedematous. 

2. Tumor in the pit of the stomach. This is present, however, 
only when the cancer invests the pylorus. In this case we ob- 
serve a roundish, or oval, or irregular lump to the right above 
the navel under the upper part of the right rectus abclominalis 
muscle. It is always there, and cannot be moved, if the pylorus 
should have formed adhesions with neighboring organs ; but it 
changes position and is movable, when those adhesions are not 
formed. In this latter case it gradually sinks down into the 
abdominal cavity, and may appear below the navel, or even but 
little above the symphisis pubis, either as a movable or fixed 
tumor. But when the pylorus-carcinoma is covered by the left 
lobe of the liver, or by a distended colon, it cannot be felt. The 
same is true, when carcinoma has its seat on the cardia or on the 
lesser curvature. Cancerous degeneration of the arterior wall of 
the stomach is felt as a resisting mass in the epigastrium, chang- 
ing position, however, according to the position of the patient ; 
and according to the fulness and emptiness of the stomach, may 
be felt more towards the right or towards the left side, higher up 
or lower down, even below the navel. 

3. The stricture of the pylorus causes, further, a sinking in of 
the abdomen; the intestines are empty, because the food is pre- 
vented from going through the pylorus; the abdominal walls 
are thin, wrinkled, like parchment; they may be lifted up in 
folds which remain; the subcutaneous cellular tissue is wasted 
away, and the full percussion sound is wanting. The spine even 
may be felt through the abdominal walls, and the aorta descend- 
ens pulsates perceptibly. When there is a stricture of the cardia 



492 STOMACH. 

the epigastric region is fallen in because not sufficient nourishment 
is allowed to enter the stomach; the intestines are likewise empty, 
only the ribs and the processus xyphoideus protrude. 

4. Vomiting. This happens if there is a stricture of the py- 
lorus, generally from four to five hours after eating. The masses 
which are thrown up are digested. In case of stricture of the 
cardia, the vomiting takes place immediately after or even dur- 
ing eating, without nausea or exertion ; it is only a regurgitation 
of the swallowed food. If diverticles or widenings of the oesopha- 
gus exist at the same time, the vomiting follows a little later. 
The masses which are thrown up are the same as swallowed. 
If the cancer has its seat on another part of the stomach, the 
vomiting may be entirely absent; or it may, after having been 
regular for a time, slacken off and cease altogether. So also, the 
vomiting may cease if the stricture of the pylorus, by softening, 
gets removed, or if the walls of the stomach, by diffused cancer- 
ous degeneration, lose all power of contraction. 

5. Haemorrhages from the stomach. The blood is thrown up 
either decomposed as a brownish, chocolate-like mass, or when 
larger blood-vessels have been destroyed, as clear blood. 

6. The pain in the epigastrium, which has its seat generally in 
the cancerous tumor, is worse from eating, usually of a lancinat- 
ing or burning character, and never extending to the spine ; it may 
be absent altogether. 

7. The appetite is generallj' diminished; in some cases, however, 
it is increased; but the patients are afraid to eat, because of the 
following pain and vomiting. 

8. The stool is usually retarded; but when the cancerous 
growth softens and dissolves, we observe colliquative diarrhoea, 
and when there is haemorrhage in the stomach, bloody evacua- 
tions. 

Differential Diagnosis. — At its commencement it can hardly 
be distinguished from a chronic catarrh of the stomach; but in 
its progress cancer has the following distinguishing features: 
often a tumor in the epigastrium; now and then coffee-ground 
looking emesis; rapidly-developing marasmus; ashy or yellow- 
ish color of the face; and the age of the individual — over forty 
years; all of which is not applicable to chronic catarrh of the 
stomach. 

The symptoms of cancer are also verj T similar to those of the 
perforating ulcer of the stomach. Both have pain; both may have 



CARCINOMA OB. SCIRRHUS VENTRICULI. 493 

coffee-ground emesis; both may have haemorrhages from the 
stomach, and even a tumor in the epigastrium. But cancer 
never sets in before the fortieth year of age, lasts on an average 
not longer than one year, shows a steady progress in general de- 
cay, and its pain does not extend through to the spine, but is 
often combined with swelling of the lymphatic glands, espe- 
cially in the axillae and on the neck, and with sleeplessness; 
while the ulcer befalls persons mostly under forty years of age, 
may last for several years and be cured, or end quickly by per- 
foration and subsequent peritonitis, and does not so rapidly de- 
velop a cachectic appearance of general decay ; its pain usually 
extends from the stomach through to the spine. 

Cancer is distinguished from cardialgia in that it grows unin- 
terruptedly and gradually, whilst cardialgia comes in spells, 
with intervals of health ; further, by the age of the person, and 
its inroads upon the general constitution. 

How can we know what kind of cancer it is? 

A very slow progress of the disease, together with additional 
ascites, make it probable that it is a jelly-like cancer — carcinoma 
alveolaris. An acute progress and rapid growth of tumor, with 
frequent and large haemorrhages, point to carcinoma meclullaris. 
A slow progress and considerable hardness and nodulated ap- 
pearance of the tumor indicates a scirrhus. This latter is by far 
of the most frequent occurrence. 

THERAPEUTIC HINTS.— Arsen., burning pain in the stomach; 
better from warm applications; vomiting of all he takes; vom- 
iting of black substances; prostration; emaciation; restlessness. 

Bellad., cutting, clawing pain; nausea, gagging and vomiting; 
staring eyes; dryness in mouth and throat; fainting. 

Bismuth., violent, crampy pains; burning and stinging in the 
region of the stomach; stomach enlarged, hanging down to the 
crest of the ilium ; hard lump between the navel and the edges 
of the lower ribs on right side; scirrhus of the pylorus; abdomen 
bloated in ridges, with great rumbling of wind along the colon, 
which is rarely passed off, but then gives relief; vomiting, only 
in intervals of several days, when the stomach has become filled 
with blood, and then of enormous quantities, and lasting a whole 
day. 

Carb. veg., burning pain, extending from the pit of the stomach 
into the small of the back; anxiety; cold extremities; cold, 
sticky sweat; intermitting pulse. 



494 STOMACH. 

Carb. an., saltish water rises from the stomach and runs out of 
the mouth, accompanied by retching, and followed by violent, 
empty eructations, cold feet and hiccough ; pressure, clawing, 
griping and burning in the stomach; scanty, hard stools in 
lumps; copper-colored eruption on the face. 

Conhim, vomiting of chocolate-colored masses, sour and acrid; 
pressing, burning, squeezing pain, extending from the pit of the 
stomach into the back and shoulder. 

Cimdur., a case well diagnosticated by Friedreich improved 
remarkably under the administration of the tincture. 

Hydrast, vomits everything, except water with milk; pain in 
pit of stomach ; emaciation. 

Kreosot, painful, hard place on the left side of the stomach. 

Laches., gnawing pressure, relieved after eating, but coming on 
again in a few hours, and the more violent the emptier the 
stomach ; great sensitiveness to contact, especially to that of his 
clothes; drunkards. 

Lycop., after eating or drinking, vomiting of dark, greenish 
masses; bloatedness of the stomach and bowels; rumbling in the 
bowels; obstinate constipation; hard swelling in the epigastric 
region. 

Mezer., great emaciation; the muscles of the face are tensely 
drawn, like strings; constant vomiting of chocolate-colored masses, 
with great burning in the throat; violent retching, accompanied 
with the agony of death; sleeplessness and exhaustion; obstinate 
constipation; hard lumps in the epigastric region. 

Phosphor., epigastric region sensitive to the touch; constant 
nausea and fulness in the stomach; after eating, or drinking even 
a swallow of water, vomiting of a sour, foul-smelling fluid, which 
looks as though it had been a mixture of water, ink and coffee- 
grounds; in the sunken abdomen, a circumscribed, hard swelling; 
pale, earthy complexion; great emaciation; sleepiness; peevish- 
ness; fine gurgling noise in the abdomen; urine scanty, red, or 
brown, with reddish or yellowish-red sediment; bowels consti- 
pated, dry, rumbling stools. 

Sepia, sour taste after eating; vomiting of mucus, caused by 
taking even the simplest food; the pain in the stomach increases 
by vomiting, and extends to the back, with anxiety ; oppression 
of the chest and cold perspiration ; hard places in the region of 
the pylorus; constipation. 

In addition, compare the Round Perforating Ulcer. Gastralgia, 
Catarrh of the Stomach and PLemateinesis. 



HAEMORRHAGE FROM THE STOMACH. 495 

Haemorrhage from the Stomach, Hsematemesis, 

Consists of an effusion of blood, either from the arteries, veins or 
capillaries of the stomach, and may have two distirict causes, viz. : 
1. An increased pressure in the blood-vessels. Such is the case, a. 
In all congestive, catarrhal and inflammatory affections of the mucous 
membrane of the stomach. The bleeding in such cases is not very 
considerable, and comes from the capillary vessels, b. In all 
those cases in which the free circulation of the blood is interfered with, 
as in diseases of the vena porta, liver or spleen, in consequence 
of constriction of the inferior vena cava, in heart and lung dis- 
eases, all of which cause a mechanical interference to the free 
circulation, and, in consequence, a stagnation and greater pressure 
of the blood in the mucous membrane of the stomach. The 
bleeding in such cases is mostly capillary only; but it may 
amount to large quantities, if the pressure be great enough to 
rupture larger blood-vessels, c. In cases where habitual bleedings 
have been suppressed, menstrual or hemorrhoidal. Such bleedings 
are called vicarious. 

The second distinct cause of haemorrhage from the stomach 
depends upon morbid alterations of the coats of the blood-vessels; these 
may arise — a. From chemical or mechanical influences, such as 
alkaline or corroding substances, or pointed objects within the 
stomach; from violent vomiting, straining, or from the effects of 
a fall or a knock ; b. From pathological conditions, such as varicose 
veins, and aneurismal arteries ; c. From general diseases, such as 
scurvy, yellow fever, and acute exanthematic fevers; d. From 
ulcerative processes, such as the round perforating ulcer, hsemor- 
rhagic erosions and cancer of the stomach. 

Post-mortem examinations exhibit the mucous membrane of 
the stomach pale and anaemic, especially after capillary haemor- 
rhage. At times we find the mucous membrane infiltrated with 
blue or darkened patches here and there, from which the blood 
oozes on slight pressure. On such places the membrane is soft- 
ened and easily removable, whereby slight depressions are formed, 
called hemorrhagic erosions. After profuse haemorrhages we find 
clots of blood, after slow bleeding or oozing the blood generally 
is altered by the gastric juice into a substance like coffee-grounds. 
Symptoms. — Slight haemorrhages usually cause no particular 
signs, except traces of blood in the masses, which are thrown up. 
Profuse effusions cause a feeling of warmth and fulness in the 



496 STOMACH. 

stomach, nausea and vomiting, and soon all the signs of deple- 
tion, such as paleness, small pulse and cold extremities, great 
weakness, anxiety and oppression, singing in the ears, nickering 
before the eyes, dizziness and fainting. 

The vomiting brings up the blood clear, in lumps, or already 
decomposed into a chocolate or coffee-ground-like substance. 
After the vomiting there is great thirst. Sometimes no blood is 
thrown up, but it is carried off through the bowels, making the 
feces appear dark, black or tar-like. 

Differential Diagnosis. — It may be confounded with Jar mop- 
toe. Hsemoptoe is preceded by heart or lung affections, attended 
by cough. We hear rattling noises in the chest. Hsematemesis 
is preceded by affections of the stomach, liver, etc., and is at- 
tended by nausea and vomiting. 

Hamoptoe generally yields bright, frothy blood ; haematemesis 
mostly dark or decomposed blood. 

How can we discern whether the blood comes from the stomach 
or the intestines? In the first case the blood is always mixed 
thoroughly with the feces; while in the latter case it generally 
comes without fecal masses. 

THERAPEUTIC HINTS.— Aeon., in congestion and inflammation 
of the mucous membrane of the stomach ; in scarlet fever, some- 
times during desquamation, with excruciating pains in the 
stomach, gagging, retching, gasping for breath; distressed face; 
anguish; cold sweat on the forehead. 

Arnica, when caused by external injuries; overexertions; sore- 
ness all over the body. 

Arsen., headache; roaring in the head; fainting; cold, dis- 
tressed, yellowish or deadly pale, collapsed face; cold perspiration 
on the forehead; constant nausea; retching; great thirst; burn- 
ing in the stomach; bloated abdomen; stitching pain in the 
spleen; black stools; groaning and moaning breathing: quick, 
trembling, thread-like pulse, 120 to 130 per minute; coldness 
over the whole body; great weakness; trembling, anxiety. 

Bellad., congestion of the head and stomach; singing in the 
ears; flickering before the eyes; red cheeks; feeling of fulness 
and warmth in the stomach. 

Carb. veg., frequent fainting; hippocratic face; icy coldness of 
the extremities; intermitting, small, scarcely perceptible pulse. 

China, great loss of blood; and in consequence excessive weak- 



HEMORRHAGE FROM THE STOMACH. 497 

ncss; paleness and coldness of the hands and feet, like marble; 
sensitiveness to touch in the pit of the stomach. 

Colonic, in a case with bloody discharges from the bowels, and 
deadly nausea from smelling the cooking of food. 

Eriger., violent retching and burning in the stomach. 

Ferr. ac, pit of the stomach sensitive to touch, and soreness 
all over the abdomen; pulse full, excited; face pale; greatly 
exhausted. 

Hamam., previous fulness and pain in the abdomen; feverish- 
ness by spells ; bloody vomiting and stools ; weak, cold, profuse 
sweat ; weak and quick pulse ; restlessness ; fulness and gurgling 
in the abdomen. 

Hyosc, dizziness ; stupefaction ; eyes red ; face bloated ; pit of 
stomach sensitive ; dull aching in the region of the liver ; abdo- 
men bloated ; limbs numb, weak, trembling ; during vomiting 
convulsions, with loud shrieks on account of crampy pains in the 
stomach. 

Ipec, sudden attack; blood dark, black, sour; paleness; cold- 
ness ; pulse scarcely perceptible ; fainting ; anxiety ; pressure in 
stomach ; great thirst ; oppression of breathing ; constipation or 
bloody stools. 

Moschus, when the patient becomes pulseless and collapsed. 

Nux vom., throbbing pain in the head ; pale, distressed face ; 
belching; constant nausea; stomach full and distended, sore to 
the touch; burning anxiety and pressure in the precordial 
region; pain in the region of the spleen; constipation, with 
black stools; urine turbid, dark; fainting; weakness; tempera- 
ture of the skin increased; pulse full, hard, quick. 

Phosphor., bright blood; drowsiness; sleepy; face, lips, gums 
and tongue are pale ; thirsty, better from drinking cold water ; 
loathing of food ; heaviness and heat at the pit of the stomach, 
which is distended; abdomen soft; urine dark; skin warm, with 
partial perspiration; pulse quick, energetic. 

Secale, the patient lies still, with great weakness but no pain; 
face, lips, tongue and hands deadly pale: skin covered with cold 
swe # at; pulse frequent, thread-like; oppression; abdomen soft, 
without pain. 

Veratr., slow pulse; cool temperature of the skin; chilliness; 
fainting fits ; inability to stand ; moving or rising causes sickness 
in the stomach at once; cold sweat; even fainting. 

When in connection with suppressed menstrual discharges, 



498 STOMACH. 

compare Conium, Ipec, Millef., Pulsat., Sulphur; with suppressed 
hsemorrhoidal discharges, Carb. veg., Millef., Nux vom., Sulphur; 
after mental emotions, Aeon., Hyoso, Natr., mur., Phosph. ac. 

When in combination with scurvy, typhus: Alum., Arsen., 
Carb. veg., Mtr. ac, Phosphor., Phosph. ac, Sulph. ac. 

In consequence of destructive processes within the stomach, 
compare Carcinoma et Ulcus Rotundum Ventriculi. 

Gastromalacia, Softening of the Stomach. 

Post-mortem examination reveals the coats of the stomach 
softened; changed into a kind of pappy mass; it can easily be 
scraped off. The affection is more or less extended and almost 
exclusively confined to the greater end of the stomach, or fundus 
ventriculi. And, notwithstanding such a complete decay, there is 
never found any sign of any catarrhal or inflammatory or ulcer- 
ative process in the whole mucous membrane of the stomach ; 
neither is the decayed portion sharply denned, but passes gradu- 
ally over into the health}- tissues. Its symptoms are such as are 
described under hydrocephaloid, or cholera infantum, the most 
prominent of which are constant vomiting and diarrhoea. The 
latest observations on this disease make it more than probable 
that r/ostromalacia is no disease, but a chemical process of decoy after 
death. The reasons for this opinion are the following : 

1. Softening of the coats of the stomach have been found in 
perfectly healthy individuals, who died suddenly or were executed 
after they had a short time previously partaken of food. Elsdsser 
observes that the food which had been taken was easily prone to 
an acid fermentation, or contained already a natural acid, as 
wine, beer, etc. 

2. Experiments which Elsasser made show that substances 
which easily undergo the process of acid fermentation, such as 
sugar, milk, starch, etc., bring on this softening in a healthy stom- 
ach, taken out of a corpse under application of the same degree of 
heat which the body retains for some time after death. 

3. The softening of the stomach is never found in a perfectly 
empty stomach, but always only in the presence of sour contents, 
and it is almost without exception found at the fundus ventri- 
culi, that part of the stomach which lies deepest, if the body lies 
stretched out on its back, on a part, therefore, on which the fluid 
contents of the stomach must collect. Furthermore, the size of 



GA STROM ALACIA. 499 

the softened tissue has heen found to correspond with the surface 
that has been covered by these contents. Furthermore, Elsasser 
found that, if he brought the bodies of children who died with 
cholera infantum into another position, that then other parts of 
the stomach were softened, and the fundus perfectly free from so- 
called gastromalacia. 

4. The symptoms during lifetime which are ascribed to gastro- 
malacia are so inconsistent and varying, that it would be almost 
impossible to make a differential diagnosis. Some writers de- 
scribe it as an acute, others as a chronic disease; some under 
the form of cholera, others under the form of gastritis; others 
under the form of irritation, or congestion, or inflammation of 
the brain. Who is right? And the most constant symptom 
ascribed to this disease — the constant vomiting — does not very 
well agree with a softened condition of the stomach as is found 
after death. For it is almost impossible to realize that a stomach 
so far decayed could bear such contractions and revolutions 
without bursting. 

5. There is one symptom entirely absent during life which we 
should naturally suppose would necessarily occur, if such soften- 
ing were really present during life, viz., the vomiting of blood. 
Imagine the entire destruction of so large a piece of membrane, 
which is full of blood-vessels, without any bleeding ! And yet, if 
this same organ is artificially injected after death, the injected 
matter escapes from all parts of the softened surface, why should 
not the blood during life do the same ? 

6. According to latest observations it appears that in extremely 
rare cases the softening of the stomach may begin before death, 
and even proceed to complete perforation. (Lauber.) 

I will close by simply suggesting that time and research may 
reveal the fact, that many other conditions, now considered to be 
the result of morbid processes in the living organism, are but the 
products of changes which the body undergoes after it has been 
given over to the sole influence of chemical and mechanical 
agencies. 



500 INTESTINAL CANAL. 

b. DISEASES OF THE INTESTINAL CANAL. 

Catarrhus Intestinalis, Enteritis Catarrhalis, Intestinal 
Catarrh. 

In its acute form this affection presents the same appearance as 
that by which a catarrhal inflammation of any other mucous 
membrane is characterized — injection, swelling, infiltration of 
the submucous tissue ; besides there is almost always swelling of 
the solitary and Pyer's glands, also frequently hypersemia and 
enlargement of the mesenteric glands ; the serous fluid is mixed 
with epithelial cells changing gradually into a thick, turbid 
phlegm, which adheres to the walls of the intestines. 

Primarily, it may take place after overloading the stomach, 
the use of purgative medicines, taking cold, and after mental 
emotions. 

Secondarily, it accompanies tuberculosis, cancer, typhus, puer- 
peral fever, pneumonia, dentition, and wide-spread external in- 
flammations in consequence of burns. 

The Symptoms vary according to the locality of the affection. 
A catarrhal inflammation of the duodenum, is almost ahvays 
found in connection with catarrhal inflammation of the stomach, 
and is characterized by obstruction of the ductus choledochus 
and consequent icterus. A catarrhal inflammation of the colon 
almost always extends to the rectum, and is characterized by 
colicky pains, also pains in the sphincter ani, tenesmus, and 
burning at the anus. A catarrhal inflammation confined to the 
rectum alone offers the same symptoms. 

In all cases, however, diarrhoea is the most permanent symp- 
tom, except where the inflammation is confined to the upper por- 
tions of the small intestines, when there may be no diarrhoea at 
all. The color of the discharges is at first usually green, from 
an admixture of bile which has not been changed by the normal 
digestive process; later, when the discharges become more abun- 
dant, the dejections grow pale and whitish. In case of affections 
of the lower portion of the colon and of the rectum, the evacua- 
tions are slimy and even bloody. The frequency of stools varies 
according to the severity of the case. The evacuations are usually 
preceded by sharp, cutting pains in the abdomen, which subside 
after each evacuation. Severe cases are attended with fever, 
headache, delirium, want of appetite, sickness of the stomach, 
and thick coated tongue. 



INTESTINAL CATARRH. 501 

Secondary catarrh of the intestines, according to its seat, presents 
the same symptoms, hut modified by the original affection and 
sometimes disguised by it. That which ensues in consequence 
of severe external burns, according to Curling, usually sets in at 
or about the tenth day after the injury, and is characterized by 
a sharp pain in the epigastrium and towards the region under 
the right ribs, and sometimes by a severe diarrhoea. 

In most books we find a chapter on "enteritis" or inflammation 
of the bowels. The term is too wide. It embraces what we have 
to diagnosticate specially : as dysentery, ulceration of the bowels, 
peritonitis; in short, any inflammatory affection of the bowels, 
and is, therefore, worth about as much as the enchanting term 
of "liver complaint." 

THERAPEUTIC HINTS.— Aeon., after checked perspiration; fre- 
quent, scant}'', and loose stools with tenesmus; green stools, like 
spinage; jaundice. 

Aloes, pain and rumbling in the bowels before stool ; escape of 
large quantities of wind with the stool. 

Ant. crud., disordered stomach from sour wine or beer ; white 
tongue; watery discharges; thirst at night. 

Aranea, colicky pain and diarrhoea daily at the same hour, with 
a feeling as if the arms and legs were asleep. (Nunez.) 

Arsen., after chilling the stomach by taking cold substances ; 
painful or painless diarrhoea; worse about midnight; sudden 
prostration and great thirst; also diarrhoea in consequence of 
severe external burns. 

Benz. ac., fetid, white, frothy stools, like soap-suds; urine high- 
colored and very offensive; child weak and very cross; wants to 
be nursed all the time. (A. Korndoerfer.) 

Bryon., when the weather changes suddenly from cold to warm, 
or from warm to cold ; in the summer season ; after eating fruit 
or sour-krout; after vexation and anger; painful diarrhoea, worse 
from motion and in the morning. 

Calc. carb., during dentition, with vomiting and diarrhoea, which 
is generally worse in the after part of the day. 

Chamom., painful diarrhoea of little children; they draw their 
limbs up ; their belly is bloated, hard ; the discharges are watery, 
or greenish and slimy, or undigested, looking like chopped eggs; 
there is rumbling in the bowels, and soreness of the anus; jaun- 
dice. 



502 INTESTINAL CANAL. 

China, frothy diarrhoea, generally painless; after sour beer; 
with a great deal of fermentation in the bowels; worse after eat- 
ing, and in the night. 

Collin., diarrhoea of children, accompanied with colic, cramps, 
flatulence, etc. 

Coloc, with every pain he doubles up, or presses the belly 
against a hard object. 

Corn, circ, dark and bilious stools, with griping and tenesmus ; 
general debility and nervous excitability; chilliness, followed by 
flushes of heat and sweat. 

Crot. tigl., suddenly gushing out of yellowish watery substances, 
with pain before. 

Dulcam., when the weather changes suddenly to cold; cold, 
chilly feeling in the small of the back ; griping in the region of 
the navel, with nausea in the stomach. 

Ferrum, painless, large, watery discharges, with a good appetite. 

Ipec, diarrhoea and vomiting during dentition ; in consequence 
of eating sweet, fat, or sour things (raisins, pound-cakes, pastry, 
salad, etc.); accompanied by pain in the bowels; paleness of the 
face ; cold extremities ; even spasms. 

Iris vers., burning in the' rectum and anus after a passage; 
painful, green discharges ; periodical spells of diarrhoea, always 
at night about two or three o'clock. 

Jatropha, painless diarrhoea, worse in the morning, thin, watery, 
with loud rumbling, and gushing out of stools. 

Leptand., profuse, watery stools, followed by severe cutting pains 
in the small intestines ; after exposure to wet, damp weather. 

Magn. carb., stools green, like scum on a frog pond ; sour, frothy; 
or with white, floating lumps, like tallow. Colic before, better 
after stool. 

Mercnr., great straining, cannot get done; discharges slimy, 
green or bloody; from taking cold; worse in the evening; jaun- 
dice; chaffed at anus. 

Nux vom„ always after previous use of quack medicines, teas, 
laudanum, brandy, lavender, peppermint, etc., frequently worse 
early in the morning. 

Podoph., diarrhoea, which changes constantly in appearance, 
now green, now yellowish, now whitish, slimy, etc. ; always worse 
in the forepart of the day; during teething; rolling the head from 
side to side. 

Pulsat, chilliness; thirstlessness ; bitter taste in the mouth; 



CHRONIC INTESTINAL CATARRH. 503 

coated tongue; diarrhoea worse at night; disordered stomach; 
nausea. 

Rheum, during dentition; the whole child smells sour; sour 
discharges, green, brown, fermented; great pain in bowels and 
crying; pain worse at once from uncovering an arm or leg. 

Rhus tox., great pain in the bowels before evacuation, which is 
greenish, and contains jelly-like globules or flakes; worse in the 
night or when keeping quiet. 

Rumex, diarrhoea in the morning, with cough from tickling in 
the throatpit. 

Sulphur, either without pain or with straining; always worse in 
the morning, driving out of bed ; excoriating the anus. 

Veratr., in summer season with vomiting, coming on suddenly 
at night, generally painless; white. Great thirst; feels worse 
after drinking. 

Chronic Intestinal Catarrh. 

Its pathological features differ much from those of the acute 
form. The mucous membrane of the intestines appears livid, 
brownish-red, or gray, slate-colored ; it is thickened and swollen ; 
its follicles are hypertrophied, and the whole surface is covered 
with a tough, grayish, sometimes transparent and jelly-like slime. 
In some cases all the coats of the intestines are hypertrophied, 
and polypous excrescences found upon it. Sometimes the mucous 
membrane appears pale, anaemic, and the submucous cellular 
tissue infiltrated. It is usually diffused over large tracts of the 
canal, but may be confined to the lower part of the small 
intestines or to portions of the colon. 

This form develops itself either in consequence of repeated 
acute attacks, or the frequent use of purgative medicines, or is a 
concomitant of various other complaints, such as cancer, tubercu- 
losis, typhus, obstructed circulation in the vena porta, cirrhosis of 
the liver, organic diseases of the heart and lungs, or obstruction 
in the gut itself. Its Symptoms are the following: 

1. Diarrhoea or constipation, frequently in alternation. The diar- 
rhoeic stools consist mostly of thin, fecal matter, of all colors and 
consistencies, mixed with considerable quantities of slimy, jelly- 
like matter. The hard evacuations are always covered with 
tough or jelly-like phlegm. 

2. Copious development of gas in the bowels, which causes partial 



504 INTESTINAL CANAL. 

or general distention of the abdomen and great distress to the 
patient. Its passing off gives great relief, and for that reason the 
patients make much account of it. 

3. Hypochondriacal mood. Such patients do not think or speak 
of anything but their own sufferings ; tormenting everybody with 
the same sorrowful tale. 

4. Gradual emaciation, and, in severe cases, sinking in of the 
abdomen, in which the thickened intestines can be felt through 
the abdominal walls. 

As regards its location, we may conceive the inflammation as 
situated: 1. In the upper part of the small intestines, if the patient 
complains of a dull pain in the middle of the abdomen and con- 
stipation. 2. In the lower part of the small intestines — the ileum — 
if it is attended with greenish-yellow, or yellowish-gray, watery 
stools, which, when left standing, form a sediment. 3. In the large 
intestines, if the evacuations contain large quantities of slime or 
pus mixed with blood, and are attended with a great deal of 
tenesmus. 

THERAPEUTIC HINTS.— Arg. nitr., diarrhoea, worse at night; 
watery, slimy ; always after drinking or eating soup, immediate 
discharge from the bowels, as though the fluid were rolling 
through without stopping; soreness and burning in the region 
of the sigmoid flexure ; fever; emaciation; desire for sugar. 

Arsen., worse about midnight; burning pain in the abdomen; 
discharges burning, cadaverously-smelling, excoriating the anus; 
thin, lumpy, of all colors; great thirst; restlessness; exhaustion 
and emaciation; old look in the face; very cross and despond- 
ent. 

Baptis., stools dark, offensive, exhausting; pain in liver and 
region of gall-bladder, sweat and urine extremely fetid ; little or 
no thirst; gone-feeling at pit of stomach ; frequent faintings. 

Bryon., pain in the bowels after eating or drinking; slightest 
motion brings on a discharge which looks like dirty water, show- 
ing, on standing, a whitish, finely-granulated sediment of undi- 
gested food at the bottom of the vessel. 

Calc. carb., during dentition; scrofulous individuals ; diarrhoea, 
worse toward evening; whitish, chronic, soft stools; emaciation. 

Carb. veg., great collection of wind in the abdomen ; frequent 
discharges of very fetid flatus without relief; stool, even if soft, 
is passed with great difficulty, similar to Cinchona. 



CHRONIC INTESTINAL CATARRH. 505 

Coccul., diarrhoea only through the day, thin, yellowish, with- 
out pain; great rumbling in the bowels; hectic fever; general 
emaciation. 

Coloc, chronic diarrhoea in the morning; watery; with pain in 
the sides of the abdomen. 

Crot. tigl., diarrhoea, with nausea; watery discharges gushing 
out forcibly ; worse after drinking, and in the summer season. 

Gelsem., when diarrhoea is always brought on by exciting news, 
fright or emotions of the mind. 

Graphit, a quantity of white mucus is expelled with the stool, 
or the hard feces are covered with slime. 

Ghimmi guti, pain in ileo-csecal region, which is sensitive to the 
touch ; discharges watery, slimy, undigested, without smell ; dur- 
ing stool, bearing down and colicky pain, prolapsus ani, and cold 
sweat on the limbs. Also thin, yellow, fecal or watery, frequent, 
copious stools, coming out all at once; worse in the forenoon; 
sudden urging; after stool great relief in abdomen. 

Hepar, especially after the abuse of mercury, with longing for 
sour or strong-tasting things ; empty, sinking feeling in stomach, 
relieved by eating. 

Ipec, cured a chronic diarrhoea with clean tongue and frequent 
nausea, constant pain at umbilicus; miasmatic origin. Aided 
by milk-diet. (W. L. Dodge.) 

Laches., ileo-caecal region very sensitive to touch ; after great 
straining, discharge of a mass of croupous exudation ; stools very 
offensive ; heat of abdomen. 

Mercur., discharge mostly slimy and with straining; worse 
towards evening and in the night ; gums swollen ; teeth loose ; 
sickly smell from the mouth ; the mere putting the hands upon 
something cold, causes pain in the bowels ; debility ; sweat with- 
out relief. 

Natr. mur., diarrhoea mostly through the day ; greenish, bloody ; 
or watery ; perceptible falling away in flesh on the neck ; the 
neck becomes quite thin. (Hering.) 

Nitr. ac, acute pain in the abdomen during stool ; worse in the 
morning ; discharge brown and slimy. 

Nuphar hit, stool liquid, light yellow ; the call is urgent, must 
go quick, every morning at six o'clock, and followed by two or 
four more passages in a few hours, and no more until next 
morning. (J. L. Gage.) 

(Enoth. bien., relieves the melancholy and low spirits which ac- 
company the chronic form. (J. S. Douglass.) 



506 INTESTINAL CANAL. 

Petrol., slimy discharge ; also, brown fluid or pappy evacuations ; 
pain in the bowels ; before dusk a sensation of unpleasant motion 
and grasping in the bowels; disgust for meat, especially fat; 
bitter-sour taste in the mouth; cold feeling in the abdomen. 
Diarrhoea, sometimes only during the day. 

Phosphor., painless, watery discharges ; especially in the morn- 
ing after getting up ; in debilitated, consumptive patients ; lying- 
in women, etc. ; burning of the palms of the hands ; great weak- 
ness ; emaciation. Worse in warm weather. 

Phosph. ac, painless, watery discharges, with great rumbling in 
the bowels ; during cholera epidemics. 

Sepia, jelly-like stools, with colic ; debilitating diarrhoea ; worse 
after milk ; the whole aspect of the patient indicates a deep-seated 
disturbance in the digestive functions. 

Sulphur, diarrhoea ; worse in the night or early in the morning; 
stools yellow or brownish or greenish, mixed with blood, slime 
or pus ; feces pass off while the patient intends to relieve himself 
of flatus ; the abdomen is sore to the touch ; during stool, pain 
in the small of the back ; palpitation of the heart ; congestion of 
the head ; prolapsus ani ; itching, burning, smarting in the anus 
and rectum. 

Frequent alternation of costiveness with diarrhoea suggests: 
Ant. crud., Arg. nitr., Arsen., Bryon., Graphit., Natr. mur., Phos- 
phor., Rhus tox., Ruta, Sepia. 

Copious development of gas: Carb. veg., Coccul., Graphit., 
Nitr. ac, Phosphor., Pulsat. 

The patients think and talk of nothing but their ailments : 
Arsen., Calc. carb., Coccul., Mercur., Nitr. ac, Phosphor., Sepia, 
Sulphur. 

Emaciation and sinking in of the abdomen : Arson., Borax, 
Calc. carb., China, Ferrum, Graphit., Iodium, Laches., Lycop., 
Natr. mur., Nitr. ac, Nux vom., Phosphor., Phosph. ac, Pulsat., 
Silic, Staphis., Sulphur, Verat. 

Typhlitis, Perityphlitis and Inflammation of the Vermi- 
form Process. 

Although, anatomically speaking, these are" three distinct forms 
of diseases, yet, considering them in a diagnostic point of view, 
their symptoms during life are so intimately interwoven, that a 
differential diagnosis among them is rarely possible. 



TYPHLITIS, PERITYPHLITIS. 507 

Typhlitis is an inflammation or catarrh of the mucous mem- 
brane of the caecum, in consequence either of cold or accumula- 
tion of hardened feces or foreign bodies, such as cherry-stones, 
plum-stones and the like. It may spread over a considerable 
portion of the colon ascendens, and to the vermiform process ; it 
may spread to the muscular layer of the gut, cause ulceration 
and even perforation of these parts, and terminate in peritonitis, 
inflammation of the loose areolar tissue around the caecum, and 
formation of abscesses in the right iliac fossa. 

Perityphlitis is an inflammation of the loose areolar tissue 
around the caecum, either in consequence of typhlitis, or starting 
here independently; it is attended with a feeling of numbness 
and formication in the right limb and but little meteorism. It 
terminates, if not checked, in the formation of abscesses in the 
right iliac fossa, which either discharge into the neighboring 
viscera or break through the abdominal parietes, mostly in the 
neighborhood of Poupart's ligament. As such abscesses, if not 
originally caused by perforation of the csecum from within, 
mostly perforate the posterior wall of this organ, it occasionally 
happens that the abscess, when it discharges exteriorly, contains 
fecal matter also. 

Inflammation of the appendix vermiformis may be caused, like 
typhlitis, by hardened fecal matter or foreign bodies. It termi- 
nates either in obliteration of this process, or, when its opening 
gets closed, in an accumulation of a slimy, serous fluid, by which 
its walls become distended, forming the so-called dropsy of the 
appendix, or in the formation of abscesses in the right iliac fossa, 
or, lastly, in more or less extended peritonitis. 

The Symptoms of these three pathological states we may sum 
up under the following heads : 

1. External swelling. It makes its appearance in the right ileo- 
csecal or ileo-inguinal region of the abdomen. It is felt directly 
under the abdominal wall, which is movable upon it, except in 
such cases where a perforation to the outside is going to take 
place, and exhibits in most cases considerable heat and redness. 
The swelling itself is immovable, its surface feels smooth, and its 
consistency varies in degree; it may reach sometimes the hard- 
ness of a stone; fluctuation is seldom perceptible. Its growth is 
rapid; in a few days it reaches its height. This swelling is want- 
ing only in such cases in which perforation takes place, before 
yet exudation and pus formation could take place around the 



508 INTESTINAL CANAL. 

caecum, and it is not perceptible or at least not distinctly so, when, 
in consequence of peritonitis, the fluid exudation or meteorismus 
of the neighboring intestines covers it over. When perityphlitis 
follows upon typhlitis and the latter subsides, we find the exterior 
swelling likewise decreasing while a tumor deeper in still remains. 

2. Pain. It usually commences suddenly, is of a sharp, lan- 
cinating or boring nature, and increases on motion, especially 
such which put either the abdominal or the psoas muscle on a 
stretch. It is worse from touch, and confined either to the right 
iliac fossa alone or extending over a larger surface in accordance 
to the extension of the inflammation. 

3. Obstinate constipation, which may last for days, although 
interrupted sometimes. 

4. By an intercurrent diarrhoea of a slimy, watery substance. Such 
diarrhoea, however, is no favorable sign; only fecal discharges 
afford relief. 

5. Vomiting may take place at any stage of the disease, but does 
so most frequently at its height. In some cases it is very violent, 
10 to 12 times a day, is at first of a watery, yellowish or greenish 
fluid, which, however, as the disease progresses, and the consti- 
pation continues, assumes a stercoraceous smell, until, by the 
continued antiperistaltic motion of the intestines, the contents of 
the smaller intestines are forced back into the stomach, whence 
they are thrown up, affording temporary relief to the patient. 

6. Belching and meteoristic distention of the stomach and upper 
part of the abdomen. 

7. Singultus or hiccough is a frequent sign, and very distressing 
to the patient, preventing all rest and sleep. 

8. Pain in the genitals, erections of the penis, drawing up of the 
testicles, difficulty in urinating, numbness of the rigid leg, are conse- 
quences of the swelling, pressing upon the corresponding nerves ; 
while 

9. The ozdematous swelling of the right leg is the consequence of 
its pressure upon the crural and iliacal veins. Such a desperate 
condition of things must necessarily involve the whole system 

10. In fever, which is more or less violent according to the 
extent of the inflammation. 

Differential Diagnosis. — It may be confounded with 
1. Abscesses of the psoas muscle. But in this affection the swelling 
lies deeper, nearer Poupart's ligament, and more towards the 
middle line of the abdomen. It makes anv motion with the right 



INFLAMMATION OF THE VERMIFORM FROCESS. 509 

leg, which is always held in a bent position, impossible; it leaves 
the action of the bowels undisturbed ; it is associated with caries 
of the vertebrae or bones of the pelvis. Pus, when discharged 
through the abdominal walls, has no fecal odor. 

2. Tumors or abscesses of the right kidney cause the main part of 
the swelling to appear in the loin, or above the anterior termina- 
tion of the crest of the ilium. There is no disturbance in the 
action of the bowels, but the urine contains pus, bloody gravel, 
pointing at once to a diseased state of the kidneys. 

3. Tumors of the right ovary are attended with menstrual dis- 
turbance, but not with affections of the bowels ; the} 7 grow slowly, 
and from below up -out of the pelvis, where they may be dis- 
covered by a per vaginam examination. 

4. Cancer of the caecum is a very rare disease, of very slow growth, 
and attended with all the general signs of cancerous diathesis. 

5. Intussusception or invagination of the intestine may be some- 
times very difficult to be discerned from typhlitis, especially if it 
should happen to cause a swelling just in the right iliac region; 
but this is not always the case; and, furthermore, it is preceded 
by diarrhoea. As soon, however, as invagination has taken place, 
there are only bloody, slimy discharges; the obstruction of the 
intestinal canal with all its symptoms — stercoraceous vomiting, 
hiccough, etc. — is at once established, while in typhlitis it sets in 
only during the further progress of the disease. 

THERAPEUTIC HINTS. — Bellad., great pain in the ileo-cfecal 
region, cannot bear the slightest touch, not even the bed-cover ; 
nausea; vomiting; necessity of lying motionless on his back; 
high fever, increasing during the afternoon with red or pale face ; 
slight perspiration during the fever. 

Ginseng, stinging pain and swelling and gurgling noise in the 
ileo-csecal region; dry tongue; heat and delirium when going to 



Hepar, after the abuse of mercury; ileo-csecal region swollen, 
deep, in a circumscribed lump ; lying on the back with the right 
knee drawn up, as easiest position; frequent urging to stool and 
urination. 

Laches., great sensitiveness to contact of the abdomen ; swelling 
in the ileo-caecal region; painful stiffness from the loins down to 
the os sacrum and thighs ; constipation ; scanty urine, with red 
sediment; strangury; only possible position is that on the back, 



510 INTESTINAL CANAL. 

with the knees drawn up. Fever increases towards 3 o'clock, 
p.m. ; patient feels worse after sleep. 

Mercur., painful, hard, hot, and red swelling in the ileo-csecal 
region, painful to the touch; face red or pale, sickly; thirst; red, 
dry tongue ; constipation, or frequent slimy discharges with 
straining; sweat without relief. 

Plumbum, large, hard swelling in the ileo-csecal region, painful 
to the touch and least motion; or when sneezing and coughing; 
the whole abdomen sensitive; the navel drawn in; frequent sour 
belching; nausea; retching; constipation; anxious countenance; 
dry tongue, red on the edges, brown coating in the middle; great 
thirst, lame feeling in the legs. 

Rhus tox., hard, painful swelling of nearly the entire right side 
of the abdomen ; pain worse in sitting or when stretching the 
right leg ; impossibility of lying on the left side ; better when 
lying on the back with right leg drawn up ; and when gently 
pressing the swelling from below upwards ; pale, anxious face ; 
burning of the palms of the hands ; profuse sweat at night ; small, 
frequent pulse ; after taking cold by getting wet. 

Thuja, only those parts of the body perspire which are uncov- 
ered, those covered are hot and dry. 

Besides these compare Arsen., Chamom., Coccul., Colchic, 
Coloc, Lycop., Nitr. ac, Amnion., Platin., Silic, Sulphur, Veratr., 
Zincum. 

Stercoraceous smell of the vomit hints to Opium, Mercur., 
Plumbum. 

Already formed abscess in the right iliac fossa indicates Hepar, 
Mercur., Silic, Iodium., Laches., Kali carb., Lycop. 

Proctitis, Catarrhal Inflammation of the Rectum. 

This is either of an acute or a chronic nature, and its patho- 
logical appearance corresponds entirely to catarrhal inflammation 
of any other mucous membrane, exhibiting injection, infiltration, 
mucous secretion, and at last, thickening of the membrane, 
chronic blennorrhoea and ulceration. It may be caused by tak- 
ing cold, purgative medicines, medicated injections, insertion of 
pieces of soap to promote evacuations; by worms and hard fecal 
matter. 

It may, secondarily, be a mere continuation of an inflammatory 
process in neighboring organs, such as the hsernorrhoidal veins, 



PROCTITIS. 511 

the bladder, the prostatic gland, or the internal sexual organs; 
or it may accompany tuberculous, cancerous or syphilitic ulcers, 
or disorders which cause stagnation in the abdominal veins in 
general, such as diseases of the liver, of the vena porta, the heart 
and lungs. 

Its Symptoms are : pain, tearing, throbbing, burning, or as if 
something were sticking in the rectum which had to be forced 
out ; worse during an evacuation ; constant desire to evacuate ; 
tenesmus ; in severe cases, attended with retention of urine and 
strangury ; painful urination or drippling of urine ; erection of 
penis ; drawing up of testicles ; leucorrhoea. 

The bowels are mostly constipated, but the stools natural, cov- 
ered, however, with a thin layer of slime, which is colorless or 
tinged with blood. The great straining frequently causes pro- 
lapsus ani. In its chronic form the pain is more of a dull, heavy 
nature, and its most prominent symptom is the constant dis- 
charge of a thick, yellowish, even purulent secretion from the 
mucous membrane of the rectum. It covers either the natural 
discharges from the bowels, or it is mixed with the loose stools, 
(if there be such) or oozes out of the anus, staining the linen of 
the patient. This chronic form is frequently attended with 
chronic catarrh of the bladder, the uterus and vagina, and espe- 
cially with hemorrhoidal affections. In both forms the inflam- 
mation may extend to the cellular tissue about the rectum. 

THERAPEUTIC HINTS.— In ordinary acute cases there will be 
indicated either Aeon., Bellad., Nux vom. or Sulphur. 

When there is tenesmus in the rectum and bladder at the 
same time : Alum., Aloes, Capsic, Hyosc., Lycop., Natr. carb., Merc, 
subl. 

During stool, discharge of urine impossible : China, Merc. subl. ; 
during stool, erections of penis : Thuja, Ignat. ; during stool, dis- 
charge of leucorrhoea : Thuja, Zincum, Magn. mur. 

Drippling of urine : Arg. nitr., Bryon., Calc. carb., Laches., 
Lycop., Natr. carb., Petrol., Rhod., Staphis., Silic, Thuja. 

Slimy, purulent matter oozing out of the anus : Borax, Coloc, 
Sepia, Thuja. 

Prolapsus ani : Nux vom., Sulphur, Podoph., Calc. carb., Lycop., 
Bellad., Ignat. 

Polypi recti : Calc. carb., Calc. phosph., Phosphor., Silic, Thuja. 



512 INTESTINAL CANAL. 

Periproctitis 

Corresponds to Perityphlitis, being an inflammation of the areolar 
tissue around the rectum. 

Primarily it is of rare occurrence, but may be brought about 
by falls, bruises, riding on horseback, surgical operations, or tak- 
ing cold. 

Secondarily it is much more frequent, and may be a mere con- 
tinuation of inflammatory and ulcerative processes in the rectum 
or other neighboring organs, the pelvic bones, the prostate gland, 
the bladder, the uterus ; sometimes, however, it appears as part 
of a general tubercular process and puerperal inflammation, with- 
out any ulcers in the rectum. 

Its most important Symptoms are : 

1. A swelling and hardness around and about the rectum, which 
appears either back of the anus in the coccygeal space, or in front 
of it, in the perineal region. Sometimes, however, nothing is 
seen or felt exteriorly, the swelling being higher up ; and an ex- 
amination per anum, by which it might be detected, is so painful 
to the patient that it is seldom practicable. 

2. In the course of ten or twelve days, however, the hard swell- 
ing is converted into an Abscess, which breaks either outside, in 
the above-named regions, or perforates the rectum, and discharges 
through the anus. In rare cases only, does a perforation take 
place into the bladder, the vagina, the uterus, or into any other 
part of the intestines. The first is the most favorable. After dis- 
charging itself fully, it heals and nothing is left. Perforation of 
the rectum, however, frequently causes Fistula; and perforations 
into any of the other organs are still more serious in their nature. 
Instead of terminating in abscess, however, the exudation is occa- 
sionally absorbed, leaving a chronic induration of portions of the 
wall of the rectum. 

3. The pain is mostly of a dull, heavy kind, or darting in the 
region of the rectum ; worse in sitting and walking. Sometimes 
it is throbbing ; shaking chills are a sure sign that formation of 
pus has taken place. Tenesmus is also frequently combined 
with it ; also difficulty of voiding urine. 

THERAPEUTIC HINTS.— When caused by traumatic causes:— 
bruises, falls, riding on horseback : Arnica, Conium, Pulsat, 
Rhus tox., Sulph. ac. 



DYSENTERY. 513 

For heavy, dull, pressing pain : Bellad., Ignat., Nux vom. 

For darting, stitch-like pain : Bryon., Kali carb., Phosphor. 

When the siuelling is hard and inflamed: Arsen., Bellad., Hepar, 
Laches., Mercur., Pulsat. 

To bring it to a head: Arsen., Calc. carb., Hepar, Kreosot., 
Laches., Lycop., Mercur., Sepia, Silic. 

Fistules require : Caustic, Berber., Silic, Calc sulph. 

Dysentery. 

The pathological character of this affection presents the follow- 
ing features: it is seated almost exclusively in the large intes- 
tines, from the valve of the caecum down to the rectum ; occa- 
sionally, however, it passes beyond the caecal valve towards the 
ilium, but is here only seen in its mildest form. When com- 
mencing, the mucous membrane appears reddened, swollen ; the 
epithelium peels off; sometimes it is raised into little vesicles by 
an exudation beneath. Later the mucous membrane becomes 
covered in patches with a dirty-whitish, yellowish-gray, or yel- 
lowish-red substance, which, from the contents of the bowels or 
from blood, may assume a greenish or brownish color, and con- 
sists of decayed epithelial cells, slime, pus and blood globules. 
If scraped off by the knife, it discloses the mucous membrane 
beneath reddened, softened, and uneven in consequence of a ser- 
ous infiltration into the submucous cellular tissue. The solitary 
follicles are swelled and in a state of ulceration. All this causes 
a collection of putrid, bloody or purulent masses within the cav- 
ity of the gut. In a still higher degree of inflammation the mu- 
cous membrane is found decayed or changed into a soft, dark 
mass, which is thrown off and discharged, giving rise to irregu- 
lar, larger and smaller dysenteric ulcers of the colon which in 
rare cases 'may cause even perforation of the gut. Besides these 
grave destructive changes within the intestine itself, we also find 
more or less inflammation of the peritoneum, swelling of the me- 
senteric glands, hyperaemia and inflammation of the liver. 

Dysentery generally prevails epidemically, under the influence 
of a tropical climate, or one resembling a tropical climate, on a 
soil of moist and perhaps swampy character, where by miasmatic 
and atmospheric conditions a disposition to it is produced. It is 
found in camps, in hospitals, in regions where malaria prevails. 
Summer heat and in autumn, sudden cool nights are very apt to 



514 INTESTINAL CANAL. 

cause it. Sporadic cases we find, therefore, occur mostly after 
sudden check of perspiration, or after getting wet ; fruit, if ripe, 
will scarcely ever cause it, although some people do assert it. Un- 
ripe fruit, however, is always hurtful. Virchow considers the epi- 
demic form of a diphtheritic — the sporadic of a catarrhal — nature. 

Dysentery attacks all ages and both sexes. In its epidemic 
form it is believed by some authors to be contagious, especially 
when large masses of excreta become heaped together, as in 
camps or hospitals, wherefore every dejection should be consid- 
ered as dangerous. Those who deny its contagiousness do it 
only reservedly. Sporadic cases are generally considered as 
non-contagious. 

Symptoms. — 1. The stools, commencing almost always as diar- 
rhceic, change into characteristic dysenteric stools. At first we 
observe in the liquid diarrhceic stools jelly-like, transparent clots 
of slime, looking similar to boiled sago; they are dotted and 
streaked with blood and will sink to the bottom of the vessel if 
the evacuation remains standing a while. They soon increase 
and are discharged in larger quantities of jelly-like, transparent 
masses tinged with blood. As they augment, the fecal substance 
of the stool diminishes, until, finally, nothing but slime is dis- 
charged. By this time, however, its jelly-like character changes 
into an opaque, dirty-whitish, or reddish-gray appearance, like 
scrapings, swimming sometimes in a thin, bloody, watery fluid ; 
fecal matter disappears entirely. 

The blood contained in it varies in quantity from merely ting- 
ing the slime into a reddish color to clear blood. In rare cases 
only whole shreds or pieces of slough from the lining membrane 
pass away; but when the discharges assume a brownish, choco- 
late-like color, and are of a penetrating, cadaverous smell, the 
dysentertic ulcers within have become ichorous and the mucous 
membrane is decaying. When, however, fecal matter again 
makes its appearance, which generally takes place in the shape 
of hard lumps, it has always been to me a sign that the inflam- 
mation is gradually subsiding; and, although after it many more 
evacuations of mere bloody slime may take place, yet the violence 
of the disease seems broken; there is, after that, less and less 
slime discharged, until, at length, normal alvine discharges prove 
the restoration to health. 

The frequency of stools varies from four to twenty, thirty or 
even more in the course of twentv-four hours. The smell of the 



DYSENTERY. 515 

evacuations varies also. At first, as long as fecal matter is con- 
tained therein, the smell is, accordingly, stercoraceous ; later, 
when the fecal matter has disappeared, there is either no smell, 
or a peculiar, fleshy, sweatish, nauseating odor. When, however, 
the disease is at its height, and the dysenteric ulcers become ichor- 
ous and sloughing, the smell is awful, penetrating, cadaverous. 

2. Pain in the bowels and tenesmus. Characteristic of dysentery 
is the colicky, cutting and drawing-together pain in the bowels before 
and during an evacuation, ceasing soon after, to be renewed by 
another attack, thus coming in spells. The evacuations are gen- 
erally attended by great burning pain in the anus and rectum. 
In fatal cases, where paralysis of the colon takes place, the pain 
ceases altogether. Likewise characteristic is the tenesmus or 
straining during an evacuation, and continuing some time after 
although not more than a teaspoonful be voided. It is the most 
painful symptom of the disease, and may cause fainting, convul- 
sions and prolapsus ani. This symptom also ceases if, in fatal 
cases, paralysis of the colon takes place. 

3. Reflex symptoms. To these belong the vomiting frequently 
found at the beginning, but also during the progress of the dis- 
ease; singultus (which, however, is not so frequent, and then is 
generally a sign of peritonitis), retention of urine and painful 
micturition. 

4. General symptoms are, more or less fever, but the temperature 
of the skin is usually not as high as in most other inflammatory 
diseases. The skin is mostly dry. There is great thirst, little 
appetite, great loss of flesh. 

5. Secondary symptoms are, peritonitis, perityphlitis, periproc- 
titis, pneumonia, pleuritis, parotitis, splenitis, hepatitis, erysipelas, 
haemorrhages, decubitus. 

6. Unfavorable symptoms are, copious haemorrhages, ichorous, 
chocolate-colored and cadaverous-smelling discharges, great pros- 
tration of strength; great frequency and smallness of pulse; cold 
skin; cold, sticky perspiration ; livid and cyanotic face; collapsed 
abdomen, with want of elasticity of its walls; paralysis of the 
sphincter ani, so that the anus remains open ; involuntary dis- 
charges; peritonitis; perforation of the colon; shaking chills; 
erysipelas; violent vomiting, with cholera-like symptoms; obsti- 
nate singultus ; delirium ; convulsions and paralysis. 

THERAPEUTIC HINTS.— Aeon., after sudden check of perspira- 



516 INTESTINAL CANAL. 

tion; chill, high fever and dry skin; first very frequent, small, 
brown, painful, and at last bloody discharges. 

Aloes, violent tenesmus ; frequent stools of bloody water or with 
lumps of mucus, like jelly; during stool fainting or screaming on 
account of violent pains in the abdomen, especially right side, 
ceasing after stool; hunger; great rumbling along the colon; 
large quantities of flatus escape with the stools; pains in the 
small of the back; when urinating, urging to stool. 

Alum., tenesmus of bowels and bladder; no flow of urine except 
during an evacuation from the bowels. 

Apis, great tenesmus, and feeling as if the intestines were 
bruised. 

Arsen., discharges have a fetid, foul smell; consist of fluid feces 
mixed with blood, chocolate-colored; most frequent about mid- 
night; before stool, torturing sensation, as if the abdomen were 
being constricted; at the stool, a feeling of contraction in the rec- 
tum; after stool, burning in rectum and anus; trembling in all 
the limbs ; palpitation of the heart and distention of the abdo- 
men; tenesmus with burning in the anus and rectum; great ex- 
haustion, and, lastly", some short relief from pain; great thirst, 
but drinking little at a time; tongue white or brown or bluish; 
nausea; vomiting; face sunken, expressing great anguish; great 
restlessness; petechial, miliary and nettle-rash eruptions; cold, 
dry skin, or else cold perspiration; very frequent, weak pulse; 
fetid urine. 

Baptis., violent, colic-like pains before every stool and great te- 
nesmus; discharges of pure blood, with very little mucus; dry, 
brown tongue; typhoid tendency. 

Bellad., discharges greenish, slimy, bloody, with great tenesmus ; 
bearing down and shuddering; afterwards burning in the anus 
and rectum ; the mucous membrane of the anus appears swollen 
and is pressed out; urine suppressed; abdomen very sore to press- 
ure; cutting, tearing and constricting pains in the abdomen, so 
violent that the patient screams out; thirst, belching, vomiting- 
starting in sleep; delirium. 

Bryon., during summer-heat; pain and discharges are brought 
on from motion, even from turning in bed, raising the arms or 
bending the toes. 

Canthar., tremendous burning pain through the whole intestinal 
tract, from the bowels down to the anus, with painful sensitiveness 
of the abdomen to the slightest touch; unquenchable thirst, with 



DYSENTERY. 517 

disgust for all kinds of drink; loss of epithelium on the lips, 
tongue and palate; vesicles and cankers in mouth and throat; 
collapse, small pulse, coldness of hands and feet. Stools bloody 
and watery, with scrapings from the bowels; frequent urging to 
urinate, with burning after urination. 

Capsic, abdomen distended, as though it would burst; very 
frequent discharges, streaked with black blood, with violent tenes- 
mus and burning both in the rectum and bladder; thirst after 
stool, and shuddering after drinking; taste like putrid water; 
pains aggravated by currents of air, though warm. 

Carb. veg., after Arsen., if there be cold breath, cool skin, ter- 
ribly smelling discharges, general collapse. 

China, discharges chocolate-colored, of a terrible, cadaverous 
smell, worse at night; great general exhaustion. 

Colchic., discharges of white, jelty-like or bloody mucus; spasm 
of the sphincter ani during a discharge, with a shuddering over 
the back; such spasms occur also without a discharge; oedema of 
the lower extremities, which are cold; ascites; urine dark brown 
and scanty. 

Goloc, discharges slimy, bloody, like scrapings ; abdomen 
bloated; violent pain in the abdomen, as though the intestines 
were squeezed between stones, which compels the patient to bend 
double; from the abdomen rises a shuddering over the body; 
during stool, sometimes tenesmus, at other times not; after stool 
relief of the pain. After vexation or indignation. 

Diosc, stools deep yellow, thin, watery; dark green and mucous; 
severe twisting colic with intervals of relief; faint feeling in the 
abdomen after stool. 

Eriger., stools small, streaked with blood, accompanied with 
tormina; burning in the bowels and rectum ;• hard lumps of feces 
mixed with the discharges; urination painful or suppressed. 

Gummi gutti, stools watery, frequent, copious and offensive, 
coming out all at once affording great relief. 

Harnam., when the amount of blood is unusual in quantity and 
amounts to an actual haemorrhage, generally of dark blood; or 
when there are clots or patches of blood scattered through the 
mucus. Soreness of the abdomen. 

Ipec, when caused by eating unripe, sour fruit; great disgust 
and loathing of any sort of food ; sickness and vomiting of grass- 
green, jelly-like mucus; coated tongue; headache; chilliness; 
great pressing to stool; voiding slimy, bloody, offensive dis- 
charges, with subsequent tenesmus; worse in the evening. 



518 INTESTINAL CANAL. 

Kali bichr., discharges brownish, frothy water, bloody, Avith 
gnawing pain about the umbilicus; violent painful pressing, 
straining and tenesmus; tongue smooth, red and cracked. After 
Canthar. 

Laches., discharges chocolate-colored, of a cadaverous smell; 
during evacuation burning in the anus; cramp-like pain in 
abdomen; coldness; thirst; abdomen very hot; tongue red and 
cracked at its point, or black and bloody. 

Magn. carb., stools green, watery, frothy, with green scum like 
that of a frog pond ; bloody mucus. In hot weather ; during the 
day; during dentition. Abdominal pain before and during stool; 
tenesmus. 

Mercur., discharges excoriating; before stool: cutting, pinching, 
and twisting pains in the abdomen; anxiety and trembling; 
during stool: burning in the anus; eructation, nausea ; faintness, 
colic, heat and perspiration; after stool: great tenesmus; cannot 
get done; prolapsus ani and trembling; the abdomen generally 
feels cold; bad taste in the mouth; saltish saliva; rheumatic 
pains in the limbs ; all worse at night. 

Merc, subl., with almost constant cutting pains in the abdomen, 
and intolerable, painful, almost ineffectual, pressing, straining 
and tenesmus; frequent, scanty discharges of bloody slime, day 
and night, with great tenesmus of the bladder. 

Natr. carb., straining and tenesmus, with a voluptuous sensation 
in the genitals. 

Nitr. ac, profuse discharges of blood; before stool: colic; during 
stool: spasmodic contraction of the anus; cutting and straining 
in the anus and rectum; after stool: burning in the anus; inef- 
fectual straining; colic; exhaustion; anxiety and general uneasi- 
ness. Pulse intermits every third beat. 

Nux vom„ always after previous abuse of diarrhoea mixtures, 
pain in the abdomen before and during a discharge, with tenes- 
mus, relieved after stool; pressing pain in the back, as if broken, 
before and during stool ; sickness in the stomach. 

Plumbum, in violent cases with blood}' masses of exudation- 
burning in anus during discharge and long-lasting tenesmus 
afterwards. 

Pulsat, discharges white-slimy; whitish-coated tongue; pappy, 
sticky taste in the mouth, without thirst; great difficulty in 
breathing; all worse at night. 

Rhus tox., discharges jelly-like; pains in the abdomen and 



CHOLERA. 519 

limbs, worse when lying still, better from moving about; noc- 
turnal exacerbation ; after getting wet. 

Staphis., cutting pain before and after stool; tenesmus in rectum 
and bladder during stool ; always worse after drinking cold water. 
After indignation. 

Sulphur, when other remedies have failed; when, during stool, 
burning, cutting, pressing and prolapsus recti, cutting in urethra, 
catching of breath, palpitation, chills about the lower part of the 
body; and afterwards, straining and throbbing in the rectum, 
bruised pains and pinching in the abdomen, chills and lassitude. 
Worse early in the morning, driving out of bed ; faintish feeling 
in pit of stomach about 10 or 11 a.m., etc. 

Thrombid., tenesmus, prolapsus ani; discharge of mucus, pus, 
blood and occasional fecal matter. Skin dry, tongue coated, 
thirst moderate. 

Schiissler: Kali mur., in most cases; if not Calc. sulph., especially 
if the discharges consist of pus-like slime. If the tongue gets dry, 
with a delirious state and distention of abdomen and the dis- 
charges have a putrid stench : Kali phosph. The same if much 
pure blood passes off. If it begins with violent fever first: Ferr. 
phosph. In case of spasmodic bellyache, relieved from pressure 
and doubling up: Magn. phosph. If the pain is depending on 
inflammation, making no intervals, and increased by pressure: 
Ferr. phosph. 

Cholera. 

A case of true cholera exhibits the following symptoms : Being 
preceded in most cases by profuse diarrhceic stools the bowels are 
quickly emptied of their contents. The discharges change to a 
rice-water like fluid, and are accompanied with profound pros- 
tration. Upon drinking follows vomiting, at first of the contents 
of the stomach and afterwards of mere watery substances, slightly 
tinged yellow. The weakness of the patient increases rapidly and 
his voice becomes husky. The discharges now take place involun- 
tarily, the secretion of urine ceases. To the insatiable thirst asso- 
ciate great anguish and oppression of the chest and in the pit of 
the stomach, and the most painful cramps in the calves of the 
legs and in the bowels. The aspect of the patient has by this 
time changed fearfully. The eyes have sunk into their orbits, 
the nose has become pointed and the cheeks fallen in. The skin 



520 INTESTINAL CANAL. 

on the fingers is wrinkled, like that of a washerwoman — and if a 
portion of the skin is pinched, it remains as a fold. The lips, 
extremities, genitals, assume a bluish, cyanotic color. The pulse 
is so faint, that it scarcely can be felt and so is the impulse of the 
heart. The whole surface of the body becomes icy cold. 

There is no headache, but frequently the patient complains of 
darkness before the eyes, roaring in the ears and vertigo. 

All this may take place in a few hours and the patient be no 
more. 

The pathological changes, so far as they belong to the small 
intestines, are as follows: The serous (peritoneal) covering of the 
small intestines is, in consequence of capillary hypersemia, of a 
rosy color and dry, or covered with a layer of sticky fluid; its 
mucous membrane is injected, and the solitary as Avell as Peyer's 
glands are swollen, and filled with serum or solid exudation. 
The villi — those minute projecting' papilla? which are so abundant 
as to give to the entire surface a beautiful velvety appearance — 
have lost their epithelium, and the surface of the mucous mem- 
brane appears smooth, or covered with extensive extravasations. 
The colon presents at some epidemics diphtheritic or dysenteric 
signs of inflammation; at others no signs whatever. All other 
changes found post-mortem have not yielded any characteristic 
signs of cholera; they must be considered merely as accidental 
lesions, from which to make deductions would be, according to 
Buhl, a wrong to science. 

Niemeyer explains the whole row of fearful changes, which the 
entire system undergoes by this dreadful malady, in the following 
manner: 

Out of the villi, which are denuded of their natural protection, 
takes place a constant copious transudation of serum into the gut, 
therefore the rice-water discharges upward and downward, by 
which cholera is characterized; but being deprived of their epi- 
thelium, these villi lose their capability of absorbing the fluid 
which the patient takes as drink; consequently the patient con- 
stantly loses fluids, but gams none. The next natural consequence 
of this must be, that the blood becomes dark and thick, in later stages 
even black, tarry, ropy, semi-coagidatcd. Thus the blood, deprived 
of its natural amount of water, seeks for fresh fluid supply, and 
absorbs all the water contained everywhere in the tissues, in con- 
sequence of which all the tissues become dry and reduced in 
volume; the nose becomes pointed, the duels fall in, the eyeballs sink 



CHOLERA. 521 

back into their orbits, the skin wrinkles on the fingers like washer- 
women's, and remains as a fold, wherever pinched, and even 
pathological exudations, which had resisted all medication — for 
example, serous exudations of the pleural cavities, or within the 
synovial membranes of the joints — are completely absorbed, and 
moist eruptions and ulcers become dry like parchment. And 
further, it explains the cessation of all natural secretions, such as 
saliva, tears, sweat, urine and bile, simply because there is 
nothing more contained in the blood to be secreted. 

Another consequence of the blood constantly losing its watery 
constituents is this: the circulation of the capillaries becomes 
impaired, if not entirely prevented. As soon, however, as this 
takes place in the capillaries of the heart-muscle, it causes, accord- 
ing to physiological and pathological experience, a paresis of the 
heart, and thus that characteristic feebleness andfaintness of the heart's 
impulses and son ads. and the small, feeble, faint pulse of the radial 
and carotid arteries, in cholera; thus, also, the cyanotic symptoms, 
the blueness of the skin everywhere, the blue tongue, by which severe 
cases of cholera are characterized. 

On the same condition of the blood, also, depends that anguish 
for breath and hunger for air — that deep inspiration and short 
moaning expiration — which is always present in severe cases of 
cholera ; for, in order that free expiration be possible, it is neces- 
sary, not only that there should be a free admission of air into 
the air-cells, but also that a corresponding change of blood in the 
capillaries of the lungs should constantly be going on. A re- 
tardation of this flow causes an imperfect purification of the blood 
from its carbon, which fact can be demonstrated by an analysis 
of the exhaled air, which contains less carbonic acid gas than it 
does normally. The air passes out nearly unchanged, causing 
thus the characteristic cold breath of cholera patients, and as 
the vocal organs partake of the universal drying process, they 
become rigid, and naturally cause the voice of the patient to 
become changed into the peculiar cholera-voice, which is rough 
and coarse, with imperfect articu.ledion. 

Tlie very distressing and painful spasms or cramps, which contract 
the muscles into hard, round knobs, are doubtless caused by central 
irritation, and it is quite probable that this irritation originates 
in the same drying-out process which pervades the whole system- 
During the algid stage the temperature sinks to 93.5°, in rare 
cases to 88° F.; the pulse is from the start feeble, and little or not 



522 INTESTINAL CANAL. 

at all hurried ; exceptionally, only, it is as high as 96 or 100 ; 
often it becomes thready and hardly perceptible; even the heart's 
diastole may, in bad cases, be no longer recognizable while its 
systole continues. 

The Specific Cause of cholera is not yet positively known. The 
mycetic theory, however, which ascribes the origin and develop- 
ment of cholera to parasites of the lowest form and smallest size, 
seems to be the one which now-a-days is most generally accepted, 
though not sufficiently proven. 

The disease is of a most violent character, destroying life 
quickly. Its mortality is fearful ! The virtues of Homoeopathy 
alone have rendered it less fatal. If recovery takes place, all the 
symptoms may, by a perfect reaction of the system, be speedily 
extinct; but in case of imperfect reaction, the disease changes 
into a kind of typhoid fever, which is sometimes complicated with 
different local inflammatory symptoms, such as pneumonia, pleu- 
ritis, bronchitis, parotitis, splenitis, or diphtheritic exudation in 
the pharynx, intestines, vagina and bladder, so that even if the 
patient lives through the attack of cholera itself, he may be car- 
ried off by its consecutive symptoms. 

THERAPEUTIC HINTS.— The best prophylactic is no doubt Sul- 
phur, as recommended by Dr. Hering in his Domestic Physician. 
Take fine precipitated Sulphur (milk of Sulphur), sprinkle about 
half a teaspoonful of it into each stocking, boot or shoe (whatever 
you wear); repeat it about twice a week. Further, as stagnation 
in the capillary circulation of lungs and heart ensues, it is of the 
highest importance that the patient should be urged from the 
beginning to breathe as deepty as possible, in order to keep up a 
lively circulation — feeding the blood with as much oxygen as 
possible. For the same reasons the best drinks which could be 
offered to such patients might be oxygenized water. 

As there is, before and during an epidemic of this kind, gener- 
ally a prevalence of bowel complaints (cholerine), it is quite im- 
portant that these incipient symptoms should at once be attended 
to. "We shall frequently find indicated : 

Aloes, constant rumbling in abdomen with a feeling as if he 
must have a stool, but no evacuation following. (C. C. Smith.) 

Asar. eur., in nervous and timid persons, who constantly feel 
chilly, or complain of cold hands, feet, knees or abdomen, even 
the hottest room or warmest covering does not relieve this chilly 



CHOLERA. 



V23 



feeling ; constant nausea, with loss of appetite or loathing of food 
without any gastric derangement; perfectly clear tongue; rum- 
bling and gurgling in the abdomen, likewise attended with 
nausea. 

Bryon., diarrhoea in the morning after getting up, with previous 
cutting pain in the bowels. 

Carb. veg., after exposure to heat of sun or fire (cooks, black- 
smiths, masons, etc.), ushered in by haemorrhage from bowels; 
associated with flatulence. 

Chin, sulph., for the following precursory symptoms : great sen- 
sitiveness against external influences ; general weakness ; internal 
bad feeling as of coming illness; anxiety, down-heartedness, mo- 
roseness, despondency, laziness and lassitude; aversion to all kind 
of work ; chilliness, especially in the back, alternating with flashes 
of heat ; heaviness in head as from a cold ; loss of appetite, loath- 
ing and nausea; pressure in stomach worse after drinking water; 
pressure in pit of stomach up into the throat ; pain in the bowels, 
especially after eating; constipation or soft stools followed by 
weakness ; heaviness and aching in all the limbs, especially in 
the joints. For this precursory stage, which, in the different sin- 
gle persons, of course, consists only in part of these symptoms, I 
gave Chin, sulph., 0.01 to 0.06, one dose every evening, for eight 
days. None of the persons thus treated were attacked by cholera. 
If I ever should live to see another cholera epidemic, I would 
give Chin, snlph. and ozonized water. (Aegidi, A. H. Z., Band 85, 
S. 191.) 

Coloc, bloody diarrhoea, with violent pain in the bowels, ex- 
tending down into the thighs. 

Ipec, nausea and vomiting predominating without, or at least 
always previous to, an alvine discharge. 

Iris vers., violent pain at the pit of the stomach or around the 
navel, or in some cases still lower down in the abdominal region, 
at or before every fit of vomiting and purging. 

Mercur., bloody, slimy discharges, with tenesmus. 

Phosph. ac, especially in the summer season; painless, watery 
discharges ; great rumbling in the abdomen ; bloatedness ; sticky 
tongue. 

Sesale, painless diarrhoea, with tingling and numbness in the 
limbs. 

Veratr., diarrhoea, and vomiting of a turbid water, with cold 
perspiration on the forehead. 



524 INTESTINAL CANAL. 

The developed cholera may point to one of the following 
remedies. 

Camphora, Hahnemann's discovery; he says: "When cholera 
first makes its appearance, it usually attacks in the following 
way: great prostration at once; the patient cannot stand; his 
features become distorted ; his eyes sunken ; his face and hands 
bluish and icy cold, with coldness of the remaining parts of the 
body ; his features express despair, and his whole action anguish, 
as though he would suffocate ; half-stupid and senseless, he moans 
and groans in a hoarse, husky voice, expressing nothing particu- 
lar, unless questioned. He has burning in the stomach and 
oesophagus, and cramps in the calves of the legs and in other 
muscles; when touched in the pit of the stomach he screams out; 
he has no thirst, no nausea, no vomiting, no diarrhoea. In such 
cases Camphora gives immediate relief; one drop of the tincture 
on sugar every five minutes." These observations of Hahne- 
mann have been verified since by hundreds of physicians, and 
in thousands of cases. 

As additional symptoms I might mention: vertigo, nausea, 
vomiting, with cold perspiration, especially in the face ; faintness, 
asphyxia ; cramps everywhere ; the upper lip is drawn up, ex- 
posing the upper teeth. It is also recommended after previous 
use of allopathic medicine. Its beneficial action is seen in a 
gradual glow and warm perspiration all over the body ; when of 
course its use must be discontinued. Overdosing calls for Coffea. 

Next to Camphora in frecpuency of its use stands — 

Ver. alb., anguish ; fear of death, or indifference ; vertigo ; eyes 
sunken ; nose cold ; face cold, pale, distorted, bluish, bloated ; 
great thirst for cold water, and vomiting after drinking, with great 
debility or diarrhoea at the same time; the discharges arc gushing, 
profuse, rice-water-like, with cramps and colic in the bowels ; cold 
feeling in the abdomen ; tongue pale or bluish ; dry or yellow- 
coated ; cold ; voice feeble and husky ; very anxious oppression 
and constriction of the chest ; tonic cramps commencing in hands 
and feet, gradually spreading all over ; pulse very small, thread- 
like ; coldness all over ; cold perspiration. 

Cuprum, Hahnemann says: "If, after Camphora, there should 
not soon be a change for the better, apply at once Cuprum x." 
Its sphere of action is the following : very painful clonic spasms 
in different parts of the body, so that the patient cries out : great 
pressure in the pit of the stomach, worse from contact ; constric- 



CHOLERA. 525 

tion of the chest; great thirst; for a while after drinking cold 
water vomiting and diarrhoea not very prominent ; anxiety ; cold 
face; blue lips; coldness all over; skin inelastic; urine sup- 



Besides these compare the following remedies: 

Aeon., restlessness; coldness externally, but to the patient a 
sense of burning heat through the whole system ; excessive thirst, 
but cannot retain anything; vomiting and purging of green, 
watery fluid ; collapse. Two drops of tincture in half a tumbler- 
ful of water, two teaspoonfuls every half hour. (W. Boyce.) 

Arg. nitr., during the height of the disease, when the respiratory 
muscles are attacked with spasms, so that the patient can scarcely 
breathe, neither speak ; to drink a swallow of water, or the ap- 
proach of a handkerchief to the nose, causes a feeling of suffoca- 
tion, with terrible anxiety and thoughts of self-destruction ; dur- 
ing the oppression severe stitches in the pit of the stomach ; after 
taking any fluid it appears as though it were running straight 
through the intestinal canal without stopping. 

Arsen., great anguish, indescribable, with constant restlessness ; 
fear of death ; sudden prostration ; eyes sunken ; nose pointed ; 
face pale, cold, distorted ; tongue dry, brown, or black ; excessive 
thirst for cold water, but drinking little at a time, which is im- 
mediately thrown up ; violent burning in the stomach and 
bowels, worse after throwing up ; urine suppressed ; voice hoarse; 
great oppression and constriction of the chest; skin wrinkled, 
dry, cold, blue ; cramps, clonic and tonic, in different localities ; 
cold, sticky perspiration. May be indicated in all stages of the 
disease ; best sign of its proper choice is the reappearing of urin- 
ary secretion. 

Bryon. 30 , a few globules each time after vomiting alone, or 
after vomiting and purging ; it cured even the worst cases with 
loss of consciousness, inability to speak, icy coldness of the skin, 
wrinkled skin; pulselessness. (Haynel.) 

Carb. veg., in last stage ; when already the discharges, up and 
down, the cramps, and general reaction have ceased ; when the 
patient lies in a sopor, and is pulseless, with cold breath, cold 
tongue, or coldness all over, a picture of perfect collapse. 

Cicuta, violent cramps ; tonic spasms of the muscles of the chest; 
loud hiccough ; eyes turned upwards ; soporous condition. 

Laches., vomiting renewed by the slightest motion, and nausea 
attended by a great flow of saliva. 



526 INTESTINAL CANAL. 

Crot. tigl., gushing out of watery discharges mixed with whitish 
flakes, with rumbling, griping in the bowels, and afterwards 
burning in the anus; discharges always brought on after drink- 
ing and motion ; great exhaustion ; faintness and dizziness. 

Hydr. ac, when there is a rapid progress of the disease towards 
asphyxia; marble coldness of the whole body; pulselessness; 
cessation of diarrhoea and vomiting ; hiccough ; paralysis of the 
oesophagus ; when drinking, the fluid runs gurgling down the 
oesophagus ; long fainting spells ; trismus ; tetanus. 

Jatropha, violent vomiting of a whitish, jelly-like substance, 
resembling the white of an egg ; discharges from the bowels in 
gushes ; gurgling noise in the abdomen, sounding as if a bottle 
were being emptied ; cramps in the calves of the legs, drawing 
them flat ; at the same time the mind is in a kind of ecstasy and 
takes little notice of these painful spasms ; or anxiety and fear, 
as though cramps in the calves would set in ; burning of the ab- 
domen ; belly drawn in ; marble coldness of the body ; pulseless- 
ness ; cold, sticky perspiration. 

Ipec, in light cases, where the vomiting predominates over 
the alvine discharges ; vomiting mostly of a sour fluid, without 
diarrhoea. 

Phosphor., tongue coated white; excessive thirst ; vomiting af- 
ter the water has become hot in the stomach ; hiccough after eat- 
ing ; belly bloated ; rumbling and rolling in the abdomen ; the 
rice-water evacuations contain grains like tallow ; oppression ; 
great sinking of strength. 

Secale, dizziness, deafness ; painful retching ; profuse diarrhoea ; 
unsuccessful urging to urinate ; skin wrinkled ; tingling in the 
limbs; cramps and coldness; aversion to heat and being covered. 

Sulphur, first recommended by Dr. Hering, because it corres- 
ponds to its commencement in the morning, its cramps in the 
calves of the legs, its indifference of mind, and lastly its red 
spots, furuncles, etc., during convalesence. Diarrhoea and vomit- 
ing at' the same time, wakens the patient after midnight; the 
body grows cold and blue, with intense cramps in the calves of 
the legs and soles of the feet; pain in the region of the liver. 

Tabac, cold perspiration, with constant, deadly sickness and 
vomiting now and then ; cramps and tearing in the limbs. 

Consecutive symptoms may call for — 

Aeon., if there be high, inflammatory fever; hard, strong pulse; 
congestion of the head or lungs; great restlessness; fear of death. 



CHOLERA MORBUS. 527 

Bellad., congestion of the head with violent delirium ; visions 
and illusions of senses. 

Bryon., typhoid symptoms ; pain in all the limbs on moving. 

Canthar., excessive sensitiveness of the abdominal walls; burn- 
ing in the umbilical region and deep in the pelvic cavity ; rum- 
bling in the abdomen and tenesmus followed by bloody evacua- 
tions ; urination drop by drop, with great burning ; suppression 
and retention of urine. 

Mur. ac, difficult speech ; moaning and groaning during sleep ; 
sliding down in bed. 

Phosph. ac, indifferent ; without pain ; delirium ; drowsiness ; 
sopor. 

Rhus tox., typhoid condition ; red tip of tongue; pain in all the 
limbs on lying quiet. 

Tereb., if Canthar. has failed. 

Dr. J. Buchner's therapy is the following: Cholerine: Phosph. ac, 
Ipec, Veratr. Cholera: Amm.sulph., Camphora, Cuprum, Cupr.ac, 
Ipec, Veratr. Cholera paralytica: Nicot. Typhoid ex diphtheride: 
Nitr. ac. Typhoid ex morbo Brightii: Arsen., Cupr. ac, Phosphor. 
Other remedies which may be indicated: Carb. veg., Cicuta, Ox. ac, 
Jatropha, Crot. tigl., Opium, Plumbum, Secale, Tart, emet., Tabac 

Cholera Morbus, or Nostras or Europsea. 

The attack comes on almost always suddenly, and frequently 
in the middle of the night. It consists of vomiting and purging, 
spasmodic pain in the abdomen, sometimes cramps in the legs, 
rapid loss of strength, and coldness of the skin. The thirst is 
great, the vomiting constant, and the purging consists of fetid 
fluid discharges containing a large quantity of bile at first, which, 
however, gradually diminishes, until, at last, the discharges ap- 
proach the rice-water appearance without smell. The rapid and 
great loss of fluid will naturally cause similar symptoms as we 
observe in cholera Asiatica, and especially in children, old peo- 
ple or debilitated persons it may reach even a fatal termination. 
Then the intestines become paralyzed, vomiting and purging 
cease, yet the transudation continues ; the pulsations of the heart 
grow fainter and the radial pulse ceases altogether ; the sensorium 
becomes clouded and the patient sinks from sheer exhaustion. 
Yet such are only exceptional cases ; as a general event the pa- 
tients soon revive again. It prevails mostly during summer 



528 INTESTINAL CANAL. 

heat, although there are cases in other seasons ; and it seems to 
be excited especially by exposure, checked perspiration, drinking 
large quantities of ice-water, or imprudence in eating. It differs 
from Asiatic cholera in not being caused by a specific poison — in 
not being to such a degree epidemic, violent and fatal. It differs 
from poisoning with arsenic by its purging and vomiting setting 
in at the same time; while in cases of poisoning the vomiting 
almost always precedes the purging. 

THERAPEUTIC HINTS.— Compare Cholera and Cholerine. Be- 
sides the remedies there characterized may be indicated : 

Ant. crud., vomiting and diarrhoea, watery or slimy; great thirst 
for cold water, especially at night; tongue coated white; after 
sour wine. 

Cflamom., after sudden taking cold ; severe, cutting pains in the 
abdomen ; vomiting of bile ; painful, bilious evacuations ; great 
irritability of mind; impatience; restlessness; child wants to be 
carried about ; also after chagrin. 

China, discharges mostly painless, containing undigested food ; 
worse in the night, with great fermentation in the bowels, which 
are bloated ; fulness of the bowels ; sour eructations, and better 
for a while afterwards ; especially after new or sour beer. 

Diosc, vomiting and purging of watery stools, with painful 
cramps in the stomach, bowels, and extremities. 

Euphorb. cor., forcible vomiting and diarrhoea of watery fluid, 
with sinking, anxious feeling at the stomach; faintness; slow and 
weak pulse ; cool skin, feet, and hands, which become affected 
with painful cramps ; painful spasms in the intestines ; cold 
sweat on the body and extremities; death-like sensation, with 
anxiety of mind ; no desire to live unless relief comes soon. 

Ipec, if the vomiting is predominating; from sour, unripe 
fruit, etc. 

Iris vers., vomiting and diarrhoea tinged with bile, with violent 
pain in the pit of the stomach, or around the navel, or still lower 
down in the abdominal region, at or before every fit of vomiting or 
purging; burning in the rectum and anus; periodical spells of 
aggravation about two or three o'clock, a.m. 

Veratr. is the most important and the most frequently indi- 
cated remedy. Purging predominates over vomiting ; the stools 
follow in quick succession, become watery, lose all coloring mat- 
ter and are gushing out, with violent pain in abdomen, or ab- 



SUMMER-COMPLAINT. 529 

sence of pain; cold feeling; great thirst; nausea and anxiety. 
Drinking increases the symptoms. 

Summer- Complaint. 

Under this title two different affections of early childhood are 
frequently mixed up, namely, Cholera infantum and Catarrhal in- 
flammation of the intestines. Both are most prevalent during the 
heat of the summer, and both show a high death-rate of infantile 
life. 

Cholera infantum corresponds to cholera morbus, and is charac- 
terized by severe vomiting, purging, rapid prostration and coil- 
lapse. In consequence of the rapid loss of fluids through the in- 
testinal canal and the consequent suppression of urine, anaemia 
and uraemia soon result with symptoms similar to hydrocephalus. 
The child grows restless, utters plaintive cries, rolls its head, 
commences to squint and falls into stupor — a state of things 
which Marshall Hall has designated with the name of "Hydro- 
cephaloid," in contradistinction to hydrocephalus acutus, which is 
of an inflammatory nature. Compare Anaemia. 

Its Causes are: Extreme summer heat, 90° F. and above, for a 
great length of time; crowded cities with their pestilential influ- 
ences of impure air, unclean streets, etc., improper alimentation, 
the combined influence of which the tender age of infants up to 
two years is frequently not capable of resisting. 

Cholera infantum often associates with intestinal catarrh, and 
this is no doubt the reason why in common practice both forms 
are frequently confounded. Still we ought to distinguish those 
cases with severe vomiting, profuse watery evacuations, rapid 
prostration and collapse, as cholera infantum. 

The Intestinal catarrh of infants during summer heat, the true 
Summer-complaint, is an inflammatory disease of the intestinal 
tract, but preponderantly an inflammation of the large intestines, 
though both the small and the large may be affected at the same 
time, hence it is also called Entero-eolitis. Its pathological changes 
correspond to those described under Intestinal Catarrh. 

Its Causes are the same as those of cholera infantum, to which 
we must add dentition. For it is not without good reason that 
mothers most dread the second summer of their infants, and are 
loath to wean them, if possible, before that period has passed. 

The most persistent of its Symptoms is diarrhoea. The evaeua- 

34 



530 INTESTINAL CANAL. 

tions, however, vary greatly. From feculent masses at first, the 
dejections become more liquid, of a whitish or ash-colored, or 
yellowish tint, changing to green or greenish, or leaving a mere 
greenish or dirty stain on the diaper; or they are slimy, at times 
mixed with streaks of blood. As long as the dejections contain 
feculent matter, they mostly have a very penetrating smell, after- 
wards they assume a peculiar, sweetish, fleshy odor, sui generis 
of summer-complaint. 

Vomiting is a frequent symptom, but it comes and goes. There 
is generally a great deal of thirst, but the liquid taken is not re- 
tained. There is always more or less fever, and the pulse rises 
to 120 and 140 or higher. 

Acute cases generally run their course in about two weeks, 
when convalescence gradually sets in, or they assume a chronic 
nature with occasional improvements and relapses. Unfavorable 
.symptoms are: continual gagging; great frequency of the stools 
and the appearance of hydrocephaloid symptoms. 

THERAPEUTIC HINTS.— The large majority of people can not 
afford to escape the continued and excessive summer-heat by 
going to the sea-shore or to the mountains. For them it will be 
well to at least avail themselves of the few cool morning and 
perhaps evening hours, to take the child out riding, either in .the 
cars or in a children's carriage, or where a river is near, on a 
steamboat. The riding motion, as Dr. Wm. B. Chamberlain has 
truly remarked, is certainly of great benefit to the patient, and, 
in conjunction with the breathing of a purer atmosphere, will 
surely produce gratifying results. The high temperature may 
also be lowered by sponging the child all over with lukewarm 
water several times a day, and if there be excessive thirst with- 
out the ability to retain any drink, it will be well to apply a wet 
compress over the epigastrium. 

Alimentation. — The mother's milk is absolutely the best, pro- 
vided the mother be well herself. If the child has been weaned, 
resort must be taken to cow's milk, thinned by adding two-thirds 
of boiling water. The boiling water is, at least, partially freed 
from disease-germs ; it raises the temperature of the milk to a 
desirable degree of warmth, and indicates at once whether the 
milk to be used is already undergoing the process of sour fer- 
mentation or not. A little salt may he added. If milk is always 
rejected, barley well boiled and strained may be tried. Of all 



SUMMER-COMPLAINT. 531 

the artificially prepared, children's food (prepared, of course, 
always according to some scientific reasons, a la retort), I am no 
great friend. Some of them may answer very well in certain 
cases, but I know of no individual indications for their several 
uses. Sometimes I have found that a little red wine in water 
remained in the stomach, when nothing else would. Beef-tea 
I abominate, and for reasons already given elsewhere. Sim- 
ple mutton or beef-broth may be recommended ; but at times 
solid food is absolutely necessary, especially in weaned children 
who have already some teeth. It is the process of mastication 
which here comes into play and which excites the necessary mix- 
ing of saliva with the food. A mutton chop sprinkled with a 
little salt and roasted quickly on a gridiron, and a pretzel, crisp 
and fresh from the baker, often do wonders. 

Cholera infantum. — Ver. alb, and Ipec. are undoubtedly the most 
important of all remedies, but compare also Arsen., Camphora, 
Cuprum, Phosphor., Secale, Sulphur and Tabac. The special i n ~ 
dications for each are given under Cholera and Cholera Morbus. 

Summer-complaint, proprie sic dictu. 

Aeon., teething children with high fever, restlessness, crying, 
biting fists, and frequent green or mucous stools. 

Aethusa, stools watery, greenish, without smell ; milk disagrees, 
is thrown up at once, at times in coagulated lumps ; vomiting of 
white, frothy matter ; after stool and vomiting the child dozes, 
utters plaintive cries now and then, and again commences to 
doze ; its face is pale, with a painful expression around the 
mouth ; great prostration ; eyes fixed and staring ; convulsions 
with clenching the thumbs and turning the eyes downward. 

Ant. crud., child cannot bear to be touched or looked at; tongue 
coated white; violent vomiting, renewed after taking food or 
drink ; diarrhoea profuse. 

Apis, stools of various colors, offensive or odorless, painful or 
painless, usually worse in the morning. Stupor interrupted with 
shrill shrieks ; head hot ; eyes red ; tongue dry ; skin dry ; hands 
cold and blue; abdomen tender, sunken ; urine suppressed ; pulse 
thread-like ; impulse of heart violent. 

Arg. nitr., stools green, like spinach ; diarrhoea after fluids, after 
sweet things which he craves. Sopor; large pupils; periodical 
trembling of the body. 

Arsen., stools green, watery, offensive; vomiting immediately 
after drinking; great thirst, but drinks little at a time; great 



532 INTESTINAL CANAL. 

restlessness ; great prostration ; all worse after midnight. Sopor, 
or coma vigil with staring, spasmodically moving eyes ; dilated 
pupils; difficult hearing and speaking or swallowing; dry 
tongue; sooty nostrils; sunken abdomen; involuntary stool and 
urine ; stiff neck ; palsy of the extremities. 

Baptis., very offensive diarrhoea, day and night ; the child can 
only swallow fluids, no solids even after it has learned to eat. 

Bellad., stools green, with hot head and cold feet, profuse mictu- 
rition ; white tongue with red margin ; dry mouth and lips ; 
drowsy with frequent starting during sleep. 

Benz. ac, extremely copious watery stools, flooding everything 
about the child ; fetid urine. 

Borax, constant vomiting and gagging ; painless stools, at first 
frothy, thin and brown, later cadaverously smelling with little 
bits of yellow feces, or colorless and slimy; belly soft, flabby and 
sunken in ; general emaciation ; sopor ; child makes an anxious 
face when carried down stairs, or put from the arms into the 
cradle. 

Bryon., any motion brings on diarrhoea; a sudden change to 
hot or cold weather aggravates the symptoms. Great thirst with 
drinking large quantities; hot head and soporous condition; very 
fretful and irritable. 

Calc. carb., stools whitish, watery, most frequent in the after 
part of the day, often of a sour smell ; sour vomiting ; open fon- 
tanels ; sweat of the head during sleep ; old, wrinkled face ; 
cold face; cold arms up to the elbows; retarded dentition; ema- 
ciation ; bloated, big belly. The child makes an anxious face 
when being lifted up from the cradle, or being carried up stairs. 

Calc. phosph., scrawny children with dirty white or brownish 
complexion ; skull soft and thin, crackling like paper when 
pressed upon ; old, wrinkled looks of the face; dry skin, diarrhoea 
with much flatulence during dentition ; greenish thin stools ; 
longing for bacon or ham fat. Hydrocephaloid conditions. 

Camphora, the skin is cold as marble, and yet the child will not 
remain covered ; half stupid and senseless ; utter prostration. 
Vomiting and diarrhoea may be present or absent. Choleraic 
symptoms. 

Cliamom., stools watery, green, or like chopped eggs, often from 
any motion of the child, with crying, colicky pains and dra wing- 
up the legs. Teething; often one cheek red and the other pale : 



SUMMER-COMPLAINT. ")33 

hot perspiration about the head. The child is very cross, wants 
to be carried about. 

China, painless and often undigested discharges, worse in the 
night, and after eating. Also attended with colicky pains and 
fermenting in the bowels. When the looseness has been brought 
on by eating fruit ; also when the patient has become very weak 
from profuse and long-continued diarrhoea. 

Coffea, during dentition diarrhoea watery and painless, with 
sleeplessness and threathening convulsions. 

Coloc, colicky pains relieved by lying on the stomach. 

Crot. tigl., sudden forcible discharges, after drinking, while 
nursing or eating, during summer. 

Cuprum, stools green with painful vomiting; spasms preceded 
by violent vomiting of mucus; convulsions. 

Dulcam., stools green with mucus from catching cold during 
hot weather. 

Ferr. phosph., frequent stools, green, watery, or hashed, mixed 
with mucus, scanty; straining at stool, also retching. Child 
rolls its head, moans; eyes half open ; face pinched; urine scanty; 
pulse and respiration accelerated ; starting in sleep. (J. C. Morgan.) 

Helleb., loose, watery, or jelly-like stools; scanty, dark urine; 
hydrocephaloid symptoms. 

Ignat, "sudden metastasis from bowels to the brain during 
dentition; sudden paleness of face, with rolling-tossing motion of 
the head; difficulty of swallowing; delirium, with convulsive 
motion of the eyes and lips." (Lilienthal.) 

Ipec, nausea and vomiting predominate; stools green like grass, 
or fermented like yeast. 

Iris vers., nausea and vomiting of sour fluid; stools thin, 
watery, copious, tinged with bile; boils about the child's head. 

Kali brom., frequent, green, watery discharges, with violent' ab- 
dominal spasms, during which the abdomen gets hard; thrush in 
the mouth; convulsive motions of eyes and limbs. (C. Mohr.) 

Kreosot., constant vomiting and greedy drinking; stools grayish 
or white, chopped, very fetid; belching or hiccoughing, especially 
when being carried; the child moans constantly, or dozes with 
half-open eyes; face cold, with a pale bluish tinge, especially on 
the temples and around the nose and mouth; rapid emaciation; 
quick, scarcely perceptible pulse. 

Laches., most important when the discharges have a penetrat- 



534 INTESTINAL CANAL. 

ing, fetid smell and assume a purulent character. Great heat of 
"the abdomen. 

Lycop., "stool of green, stringy, odorless mucus." 

Magn. carb., sour-smelling discharges up and down; pain in the 
bowels. 

Merc, sol., dark green stools, slimy, sometimes bloody with 
tenesmus ; cannot get done. 

Natr. mur., vomiting and diarrhoea, worse during the day; 
great thirst; general emaciation, most conspicuous around the 
neck, which appears thin and shrunken. (Hering.) 

Nux vom., stools early in the morning; after errors in diet. 

Phosphor., vomiting as soon as the water has become warm in 
the stomach. (Lippe.) The anus remains open all the time the 
child is straining. (Boyce.) Hydrocephaloid symptoms from 
great exhaustion. 

Phosph. ac, painless, profuse, watery, or whitish stools, not weak- 
ening for a while, but being followed at last by great exhaustion. 

Podoph, the stools frequently change in character, and are 
usually most frequent during the early part of the day; pro- 
lapsus ani during stool. Dentition, head hot, rolling head from 
side to side, moaning; flushed cheeks; gagging, retching or 
vomiting of frothy, green mucus, or of food. 

Psorin., thin, watery stools, smelling like carrion; fretful, sleep- 
less; the entire child has a disagreeable smell. 

Rheum, griping, sour stools, the whole child smells sour. 

Sepia, stools green, smelling putrid or sour; "boiled milk par- 
ticularly disagrees." 

Silic, in thin, and scrawny children with sweaty head (Boyce), 
and sweaty, offensiveh r smelling feet. 

Stannum, "the child will not be quiet in any other position 
than carried over the point ot its mother's shoulder." (Boyce.) 

Sulphur, stools worse in the morning; psoric patients prone to 
eruptions here and there, and to excoriations behind the ears 
and between the legs. Hydrocephaloid symptoms. 

Sulph. ac, "excessively restless children, when Chamom. was of 
no service; aphthous condition; mouth generally dry." 

Ver. alb., vomiting and purging, the latter predominates: great 
thirst, but drinking increases nausea and diarrhoea. After vom- 
iting or purging great exhaustion, cold sweat on forehead: and 
cold tongue. One of the most important remedies in cholera 
infantum. 



CONSTIPATION. 535 

Zincum, "on awaking the child appears frightened and its head 
rolls from side to side; during sleep it cries out, starts and jumps; 
feet constantly fidgety." Hydrocephaloid. 

Hydrocephaloid. Compare: iEthusa, Apis, Arg. nitr., Arsen., 
Bellad., Borax, Bryon., Calc. phosph., Camphora, China, Cuprum, 
Ferr. phosph., Helleb., Ignat., Laches., Lycop., Phosphor., Podoph., 
Silic, Sulphur, Veratr., Zincum. 

Constipation. 

Constipation has a relative meaning. Some persons feel per- 
fectly well if they have a stool in two or three days. I know 
women who, in perfect health, have not more than one evacuation 
in a week. With most people one discharge every day seems to 
be the norm. Retarded action of the bowels is frequently accom- 
panied with dizziness, headache, palpitation of the heart, hypo- 
chondriacal symptoms, haemorrhoids and flatulency. If long 
continued it may lead to dilatation and hypertrophy of the intes- 
tine and in some rare cases, where actual impaction of hardened 
and dried faeces ensues, to inflammation, ulceration, and even 
perforation of the gut. 

Constipation may be brought about: by a diet containing too 
large an amount of undigestible matter (beans, corn and the like 
coarse food), which forms dry feces difficult to evacuate; by dis- 
eased conditions of the mucosa in consequence of chronic catarrh, 
which diminishes the peristaltic action of the bowels; by muscu- 
lar weakness of the intestines in consequence of anaemia, chlorosis, 
long-continued diarrhoea, the use of purgative medicines, or the 
improper suppression of the desire for stool at regular hours; by 
paralytic affections of the intestines in consequence of opium, 
lead or other poisons, or cerebral or spinal diseases; by abnormal 
losses of fluids in diabetes, profuse lactation or sweats; by me- 
chanical obstructions outside the intestines from tumors, the 
enlarged or displaced womb; or by the presence of foreign bodies 
within the intestines, such as biliary stones, fruit stones, etc. 

Retarded action of the bowels in acute diseases, such as typhoid 
fever, scarlatina, measles, etc., is always of benefit to the patient, 
and ought never to be interfered with in any crude manner. 

THERAPEUTIC HINTS.— If frequent resort has been had to pur- 
gative remedies, this bad habit must at once be stopped. A care- 



536 INTESTINAL CANAL. 

ml regulation of diet, a strict adherence to the rule: "try to have 
the bowels moved at a regular hour every day or every other 
day"; the administration of injections of luke-warm water, and 
the occasional kneading of the abdominal walls by the fist will 
go a good way in helping to improve many cases of habitual 
constipation. But all this will not do in all cases; remedial 
agents will often be required, as may readily be inferred from the 
numerous causes by which constipation may be induced. For 
lazy chaps and wise ones, who either do their whole business with 
Nux vom. and castor oil, or sneer at the symptom under 
Alumina: "the rectum is inactive," because they imagine that in 
constipation the rectum must necessarily ahvays be inactive! — 
the following special hints are not written : 

Msc. hipp., dry, uncomfortable feeling in the rectum, as if it 
were filled with small sticks; very painful haemorrhoids, with 
little bleeding; aching and lame feeling in the small of the back, 
extending to the sacrum and hips; worse when getting up after 
sitting. 

Alum., the rectum is inactive, there is no desire for stool; the 
evacuation can be effected only by straining the abdominal mus- 
cles, even when the stool is soft; stools hard, knotty and scanty, 
or sticking to the anus like putty; ailments from lead. 

Amm. mur., hard stools, crumbling to pieces when evacuated, 
requiring great effort to expel them, followed by soft stools; feces 
covered b} 7 glairy mucus. 

Anac, urging without being able to expel anything; the rec- 
tum feels as if stopped up with a plug; the expulsion not taking 
place immediately, he experiences a painful twisting and turning 
in the intestines across the abdomen. 

Bryon., hard, dry stools, as if burnt; of large size and passed 
with difficulty; rheumatic tendency: irritable and prone to fits 
of anger; after castor oil ; during hot weather. 

Calc. carb., hard, large, partially undigested stools; after stool 
feeling of faintness; oozing of a fluid from the rectum, smelling 
like herring-brine; too early and too profuse menstruation; rest- 
less sleep after three o'clock a.m.; scrofulous diathesis. 

Capsic, after drinking, urging to stool, but only slime is passed ; 
feeling of heat in the abdomen. 

Carb. veg., urging with tingling in the rectum and pressure on 
the bladder; labor-like pain; discharging feces in fragments, 
which are tough and scanty; burning in bowels: tympanitis. 



CONSTIPATION. 537 

Caustic, frequent and unsuccessful urging, causing a good deal 
of pain, anxiety and redness of the face; stool comes off in 
pieces; at last soft, and of the size of a goose-quill; stool passes 
better while in a standing position. 

Chelid., stools like sheep's dung; pain in liver and caecal region; 
gurgling in abdomen, which is distended; crawling and itching 
in rectum, and reddish urine. 

China, large accumulation of feces in the intestines, with dizzi- 
ness and heat in the head; difficult stool, even when soft. 

Conium, frequent urging without stool, or a small quantity 
being expelled at a time; chilliness during stool; palpitation of 
the heart and tremulous weakness afterwards; the flow of urine 
suddenly stops and continues after a short intermission; dizzi- 
ness when turning in bed. 

Ferrum, flushed head and face with cold hands and feet; aiicemia. 

Graphit., hard, knotty stools, with tenesmus and stitches in the 
rectum; sometimes the stool is only of the size of lumbricoides; 
a quantity of mucus is expelled with the stool, or the hard feces 
are covered with mucus; itching blotches about the body, which 
emit a glutinous fluid; erysipelatous or ulcerative processes of 
the legs. 

Hepar, sluggishness and inactivity of the bowels, in consequence 
of which the abdominal muscles must bear down in order to 
effect an evacuation, which is hard or not, but insufficient; after 
mercurial dosing. 

Hydrasi, constipation, headache and piles; after stools, for 
hours severe pain in the rectum and anus; colic pains with faint- 
ing turns and heat in the bowels; anaemia; remittent fever; "after 
purgative medicines." (Goodno.) 

Iris vers., constant nausea, bitter eructations and vomiting; 
burning in epigastrium; colic with cutting pains and piles; 
hemicrania. 

Iodium, desire for stool, without evacuation ; it takes place with 
great facility after taking some cold milk; discharges of thick 
mucus, or purulent matter; part of the feces being retained. 

Kali bichr., stools dry, scanty, knotty; painful retraction of the 
anus; debility, headache, coldness of the extremities; tough se- 
cretion from any of the mucous membranes. 

Kali carb., too large-sized feces; inactivity of the rectum ; severe, 
lancinating, tearing and cutting in the anus; violent pain in the 
small of the back, as if broken. 



.138 INTESTINAL CANAL. 

Laches., constipation of years' standing; the anus feels closed; 
the feces press against it all the time without passing; only single 
flatus are passed ; the feces have a cadaverous smell ; haemorrhoids, 
with stitching pain in the varices when coughing or sneezing. 

Lycop., ineffectual urging, owing to contraction of the rectum 
(sphincter ani); distressing pain in the rectum for hours after 
evacuation; excessive and painful accumulation of flatus in the 
abdomen; red, sandy deposit in the urine. Irritable and restless 
in the afternoon. 

Magn. mur., stools large and in hard lumps; urgent pressure in 
the rectum, the stool comes out in small pieces and seems as if 
burnt; shuddering for a short time after stool. Pain and distress 
every few days in the hypogastric region. 

Natr. carb., insufficient stool, with tenesmus, followed by burn- 
ing in the eyes and urethra, with great sexual excitement, 

Natr. mur., pressure from the navel downwards into the pelvis, 
or a leaden heaviness through the pelvis and across the bladder, 
worse when walking, and better when sitting in a bent forward 
position; hard, dry stools Assuring the anus, make it bleed: a 
number of bad feelings in the anus after stool; also cutting in the 
urethra after micturition. 

Nitr. ac, hard, scanty stools ; long pressing when going to stool ; 
painful burning in the rectum, especially after micturition; urine 
emitting an intolerably strong smell. 

Nux vom., constant, ineffectual urging to stool; large, hard fe- 
ces ; piles ; headache ; unrefreshing sleep ; after previous use of 
purgative medicines; coffee and liquor drinkers; use of high- 
seasoned food ; sedentary habits. 

Opium, stools in hard, black, round balls; decided torpor and in- 
ertia of the rectum ; vomiting of stercoraceous substances in con- 
sequence of intussception ; incarcerated hernia; lead poisoning. 

Phosphor., stools narrow, dry, long, and difficult to expel: ex- 
ceedingly painful cramps in the rectum after stool. 

Phytol., constipation of long standing ; pain shooting from the 
anus and lower part of the rectum along the perimvum to the 
middle of the penis. 

Platina, difficult expulsion of scanty stool, adhering to the part 
like soft clay ; after poisoning with lead; travelling in the cars. 

Plumbum, stools consisting of small hard balls: constriction and 
drawing up of the anus; frequent, violent colic; drawing in of 
the abdomen in the region of the navel; numb extremities; 
knife drops from his hands. 



CONSTIPATION. 



530 



Podoph., constipation with great difficulty; prolapsus ani ; fre- 
quent micturition; weakness and soreness of the back; especially 
after washing. 

Prun. spin., hard stool ; intermitting stool, looking like the ex- 
crements of dogs, in small lumps, with stitches in the rectum, ex- 
torting cries. 

Pulsat, with menstrual disorders, or after suppression of inter- 
mittent fever by quinine. 

Ratan., urging sensation in the small of the back, as if there 
would be stool ; hard stool with straining; and sudden stitches 
in the anus; fissures of the anus. 

Ruta, scanty, hard stool ; frequent urging to stool, with protru- 
sion of the rectum, also during stool ; the rectum protrudes when 
stooping ever so little, and especially when squatting ; a consid- 
erable quantity of flatulence is emitted whenever the urging takes 
place. 

Sabad., violent urging to stool, with noise like the croaking of 
frogs ; necessity of sitting a long while, then passes an immense 
quantity of flatulence, which is followed by an enormous evacu- 
ation, after that, burning pain in the abdomen. 

Sarsap., obstinate constipation, with violent urging to urinate ; 
urging to stool, with contraction of the intestines, and excessive 
pressure from above downwards, as if the bowels would be pressed 
out; during stool violent tearing and cutting in the rectum; af- 
terwards a repetition of the same symptoms. 

Selen., stool so hard and impacted that it has to be removed by 
mechanical aid ; the feces contain threads of fecal matter like hair. 

Sepia, unsuccessful urging to stool, only wind and mucus being- 
passed, with sensation in the rectum as of a lump having lodged in 
it; contractive pain in the anus; thence in the perinaeum and 
vagina; oozing of moisture from the rectum. During pregnancy. 

Silic, stools composed of hard lumps ; after long straining the 
protruding feces suddenly recede into the rectum. 

Sulphur, constant urging, pressing on the rectum as if it would 
protrude, with pressing on the bladder; prolapsus ani; palpita- 
tion of the heart ; after stool excessive stinging and sore pain in 
the anus, preventing lying or sitting down ; rush of blood to the 
head ; cold feet ; faintness regularly, towards 10 or 11 o'clock, a.m 

Sulph. ac, hard stool, consisting of small, black lumps mixed 
with blood, and with such violent pricking in the anus that she 
has to rise on account of the pain ; climacteric age ; constant 



540 INTESTINAL CANAL. 

flashes of heat; tremulous sensation in the whole body without 
trembling. 

Tabac, constipation ; tympanitic bloating of the abdomen ; 
dyspnoea. 

Thuja, obstinate constipation, fever, inactivity, or intussuscep- 
tion ; hard balls; violent pain in the rectum, which prevents the 
passage; offensive perspiration at the anus and in the perinseum. 

Verbasc, scanty discharge of stool, like sheep's dung, with 
straining. 

Ver. alb., chronic costiveness with heat and pain in the head ; 
stools in black, round balls, or large and hard, or first portion of 
the stool of large size, the latter coming out in thin strings, al- 
though of the same consistence and color. During stool turning 
pale and faint, chilly with anxiety and cold sweat on forehead. 

Zincum, dry, hard, insufficient, and difficult stool; afterwards 
violent bearing down in abdomen, relieved by passage of flatus 
up or down. 

Hernia; Internal and External Strangulation. 

Both consist of a "constriction or nipping of a portion of bowel 
by the edges of some natural or artificial orifice through which it 
protrudes, with consequent arrest of the circulation of blood in 
it, and impediment to the passage of faecal matters along it." 
(Bristowe.) 

Internal strangulation may take place in the foramen Winslowii 
or the foramen ovale, or in any abnormal fissure or opening 
which has been formed by inflammation and consecutive adhe- 
sion, and formation of bands and strings within the cavity of the 
abdomen. 

External strangulation may take place in the inguinal or in the 
crural canal, in the opening which gives passage to the infra- 
pubic vessels, in the sacro-sciatic notch and in the umbilicus. 
But it does not follow by any means, that the displacement of a 
portion of the bowel in any of these by-ways should always be 
followed by strangulation. If, however, strangulation does result, 
the symptoms are the same whether it be internal or external 
strangulation: there is acute pain in the region of the lesion, 
which is followed by obstinate constipation and vomiting at first 
of yellow and greenish and later of feecal matter — Mis 

The Diagnosis of internal strangulation is obscure, because its 



HERNIA. 541 

symptoms are common to any kind of occlusion of the intestinal 
tract. External strangulation in case of ordinary hernia may 
always be detected by careful examination. 

THERAPEUTIC HINTS.— The first endeavor in any case of hernia, 
whether strangulated, incarcerated, or merely protruded, must be 
to reduce it. The manipulations used in this endeavor are called 
taxis, and consist of various procedures. The patient is laid on 
his back, low with the shoulders and high with the pelvis; the 
leg of the affected side is flexed upon the thigh and the thigh 
upon the abdomen, and then by rotating the limb inward the 
columns of the ring are relaxed. 

Or the patient is raised by his feet, so that by its own gravity 
the protruded bowel is retracted into the abdominal cavity. 

Or the patient is placed in a semi-prone position towards the 
affected side with the thigh flexed upon the body; his eyes are 
covered with a towel and then some cold water is suddenly 
dashed upon the chest and epigastrium, which causes by its shock 
a quick and deep inspiration, in consequence of which the hernia 
slips back. 

Or, according to Baron Sentin's method, "seek with index- 
finger for aperture giving issue to hernia, pushing up skin suffi- 
ciently from below in order not to be arrested by its resistance. 
Pass the end of the finger slowly between viscera and herniary 
orifice, depressing the intestine or omentum with the pulp of the 
finger. This stage demands perseverance. Now curve the finger 
like a hook, exerting enough traction on the ring to rupture some 
fibres, causing a cracking very sensible to the finger, sometimes 
to the ear. When this crack is not produced, submit the fibres 
to a continuous forced dilatation." 

Or place a jar filled with hot air over the abdomen, when, by 
cooling, the contents of the abdomen are drawn up into the jar 
and the hernia out of its enclosure — dry cupping. 

Or draw the hernia gently outwards with the right hand in 
order to disengage it from the neck of the sac, and then push 
gently with left thumb and index-finger upon the upper part of 
the tumor, thus emptying its upper portion first, when the rest 
will follow. A gentle, but persistent pressure is necessary. A 
peculiar gurgling noise in the abdomen pronounces the reduction 
of the hernia. 

Any of these methods may succeed ; but the carefully selected 



542 INTESTINAL CANAL. 

remedy may do it without them, or at least facilitate our success 
greatly and diminish more and more the necessity of the knife. 

Aeon., soreness, burning and heat and throbbing in tumor; 
excessively sensitive to touch; after fright and cold. 

Arsen., when the tumor assumes a dark red or livid appearance, 
with great restlessness and prostration. 

Aurum, the testicles are slow in lowering down into the scrotum ; 
inguinal and umbilical hernia in children from crying. 

Bellad., soon after strangulation, which is caused by spasmodic- 
action of the muscular fibres, and before inflammation has set 
in. 

Borax, if in children the anxious face is present during any 
downward motion. 

Calc. carb., rhachitic children; big-bellied and prone to diarrhoea. 

Coccul., when the protrusion takes place very slowly, as if from 
a paralytic state of the abdominal ring. 

Laches., livid appearance of the tumor ; coughing or sneezing 
goes like a knife through the tumor. 

Lycop., has been very effective in hernia of right side, with 
rumbling in abdomen and great fulness; also in women of a 
gentle disposition. 

Magn. carb., scrotal hernia. 

Nux vom., sudden violent pain in hernial region ; drawing and 
tearing, and spasmodic constriction in the abdomen, with nausea. 
vomiting of sour mucus; constipation with constant ineffectual 
urging to stool ; or, similar to Coccul., slow protrusion in aged 
persons, with squeezing pain in the hernial region, fulness in ab- 
domen, periodical nausea; tumor not very sensitive, is soft and 
doughy; later comes pinching and griping in abdomen, period- 
ical nausea, gulping up of salty or bitter water, vomiting, etc. 
Nux vom. is frequently indicated and especially if errors in diet 
have preceded; if it fails Coccul. follows well. 

Opium, soporous condition; red face; distended abdomen with 
flatus; anti-peristaltic motion, belching and vomiting: bowels 
absolutely closed, with constant urging to stool and urine. 

Plumbum, has relieved strangulation where Aeon., Bellad. and 
Nux vom. failed, in many cases. (Baumann.) 

Rhus tox., after straining or lifting heavy loads. 

Silic, "frequent colic, relieved by the discharge of offensive 
flatus; tenderness about the hernial tumor; vomits much milk 
after nursing." (Guernsey.) Boils; abscesses; offensive sweat 
of feet. 



TORSION OR TWISTING OF THE BOWELS. "43 

Stannum, "inguinal hernia; the child has curdy stools and 
much colic, which is relieved by laying its abdomen across the 
nurse's knee, or against the point of her shoulder." (Guernsey.) 

Sulph. ac, left side, in melancholic and phlegmatic persons; 
after carrying heavy loads. A'. Boenninghausen considers it as 
one of the most important remedies in inguinal hernia 1 . 

Thuja, "sweat only on the uncovered parts, while covered parts 
are dry and hot," (V. Boenninghausen.) 

Ver. alb., anti-peristaltic action, hiccough, cold sweat, nausea, 
with sensation of fainting and violent thirst. 

Torsion or Twisting of the Bowels. 

This takes place most frequently at the sigmoid flexure when, 
by a disproportion (mostly congenital) between the length of the 
Sdoop and the smallness of its mesenterial root, the overdistended 
sigmoid flexure, filled with gas and feces, is rendered liable of 
rolling about its axis, and by its own weight and inactivity is 
prevented from straightening or untying itself again. This oc- 
curs most frequently in advanced life. 

Twists also take place not unfrequently when by unusually 
long mesentery portions of the ilium are rendered freely movable 
and are thus made liable to twist around their own axis. Peri- 
tonic false ligaments or omental adhesions running directly across 
the pedicle of the twisted loop may fix it in its twisted position, 
causing, by degrees, a permanent occlusion of the bowels, which 
is often preceded for a long time by colics, meteorism and consti- 
pation. "Occlusion itself comes on acutely, with severe symp- 
toms of internal incarceration, rapid collapse, vomiting, meteor- 
ism, and usually violent tenesmus, with frequent, sometimes 
bloody diarrhoea, followed by death within the first twenty -four 
hours — on the average on the fourth day." (Leichtenstern.) 

A lateral kinking, the result of dislocation, is seen most fre- 
quently in the caecum and ascending colon, when they are ren- 
dered movable b} r an unusually long meso-colon and become 
displaced inward or into the left hypochondrium. "But the 
kinking is, in itself, insufficient to produce definite impermea- 
bility, which requires the addition of some compressing cause, 
most frequently the mesentery of a convolution of the small in- 
testine, which overlies the bent point and obstructs it by com- 
pression." (Leichtenstern.) 



544 INTESTINAL CANAL. 

Intussusception ; Invagination. 

By this is meant "the prolapse or slipping of a tuck of intes- 
tine into the cavity of the portion of intestinal tube immediately 
below it, wherewith it is continuous." (Bristowe.) It takes place 
in consequence of paresis of a limited portion of the intestine 
associated with vigorous peristaltic action of the portion below, 
just as prolapsus recti may follow violent anal tenesmus. It has 
been observed at all points of the large and small intestine. The 
ileo-csecalis is the most common form in childhood; in adults, 
ilium and ileo-csecal invaginations occur nearly as often. The 
ilium invaginations are found most frequently in the lower and 
lowest part of the ilium, while colon invaginations are more fre- 
quent in the descending colon and sigmoid flexure. 

The length of bowel involved in an intussusception varies from 
two to three inches up to three or four feet, The course of these 
lesions is also variable. Invagination may be reduced sponta- 
neously, or by suitable treatment; or the invaginated portion of 
the bowel, from being compressed, may inflame, die and slough 
off either entire, or what happens oftener, in pieces or in shreds. 

This separation occurs, in the majority of cases, from the 
eleventh to the twenty-first day after the production of the in- 
vagination; in chronic cases it may not happen until after sev- 
eral months. Or, and this is by far the most frequent in chronic 
cases of ileo-csecal invaginations, the two cylinders become fixed 
by a solid union, when after the complete disappearance of the 
swelling the canal of the invaginated portion becomes again per- 
meable; or in very acute cases, the invagination leads to imme- 
diate and permanent occlusion. The patients die in from three 
to six days, with the symptoms of internal strangulation, with or 
without peritonitis or perforation. 

The Symptoms are ushered in suddenly with violent colic, 
which is followed by vomiting, especially in children if the lesion 
be situated high up. Now follows diarrhoea, which lasts at least 
until all the contents below the lesion are discharged. These 
evacuations are always mixed with blood, which oozes from the 
compressed and congested portion of the invaginated bowel, 
and consist at last of mere bloody mucus with violent tenesmus, 
which appears earlier and is the more intense the nearer the in- 
tussusception is to the rectum. In this case there frequently fol- 
lows a paralysis of the rectal sphincter and patulence of the anus, 



INTUSSUSCEPTION. 545 

through which the Moody passages escape involuntarily, a symp- 
tom especially found in children. The next and quite important 
symptom is the usually cylindrical, sausage-like tumor, which can 
be felt in the abdomen almost always in colon and ileo-csecal in- 
vaginations, but seldom in those of the ilium. In some cases the 
intussusception extends so low down into the rectum that its 
lower extremity may be detected by the finger inserted into the 
anus. 

Invaginations especially in the small intestines are frequently 
found in the bodies of children, but unaccompanied by any 
inflammatory changes; they seem to have been produced during 
the last struggle, and must therefore be considered as mere 
cadaveric changes. — 

Ileus or Miserere are terms which denote stercoraceous vomiting 
in -consequence of any kind of occlusion of the intestine. 

THERAPEUTIC HINTS.— Ileus or Miserere hint to: Aeon., Arsen., 
Bellad., Chamom., Coccul., Coloc, Cuprum, Diosc, Lycop., Nitr. 
ac, Nux vom., Opium, Platina, Plumbum, Raphan., Rhus tox., 
Sambuc, Silic, Sulphur, Thuja, Ver. alb., Zincum. 

Aeon., inflammatory symptoms; restlessness and impatience. 

Alum., pinching pain in bowels; obstruction from inactivity 
and dryness of rectum; dry retching, or mucous vomiting; low- 
spirited, weeping, hopeless mood. 

Arsen., burning pain; restlessness and prostration; better from 
hot applications. 

Bellad., pain in right ileo-ca?cal region; cannot bear any touch; 
clawing around the navel; vomiting, can keep nothing down, is 
pale and weak. Prolapsus ani; paralysis of the sphincter ani. 
During teething. 

Carb. veg., in slow cases, when other remedies have failed and 
the pulse is intermitting. 

Coloc, neuralgic pain in bowels; obstruction as if from dryness 
of the bowels; serous, bilious vomiting without nausea; angry 
mood; throws things out of his hands ; indignation. (Hay ward.) 

Cuprum, violent pain in umbilical region; total obstruction of 
bowels; violent, continued, convulsive vomiting of blood and 
fseces; singultus; great agony. 

Kali bichr., pain as in enteritis; vomits in rapid succession 
bilious, bloody matter; the blood is bright and clotted. Listless, 
indifferent, languid mood. (Hayward.) 
35 



546 INTESTINAL CANAL. 

Nux vom., crampy, remittent pain in bowels; contraction or 
restriction of bowels; sour, mucous and bloody vomiting; quick, 
spasmodic pulse and hot skin; irritable, sullen, quarrelsome mood. 

Opium, constipation; vomiting of fecal matter; excessive thirst; 
distended abdomen, painful to touch ; crampy motions of the in- 
testine, at times like a rolling up of a hard body in right hypo- 
chondrium ; frequent hiccough ; small, frequent pulse ; cold ex- 
tremities; distorted face. 

Phosphor., paralysis of sphincter ani. 

Plumbum, violent colic in region of naval with complete obstruc- 
tion of bowels and stercoraceous vomiting; anus feels as if drawn 
upward ; swelling in the ileo-csecal region ; depressed and rest- 
less disposition. 

Thuja, ileus; spasmodic stricture, as if something alive was 
pushing out; ineffectual urging to stool, with erections. Sweats 
only on the uncovered parts of the body, while the covered parts 
are dry and hot. 

Ver. alb., colic ; burning, twisting, cutting pain with nausea 
and vomiting, worse from food, better after wind passes; cold 
skin ; cold perspiration ; small, spasmodic pulse ; restless and 
anxious. 

As mechanical means to reduce invaginations, injections of air 
have been used by means of an ordinary bellows attached to an 
oesophageal sound until a considerable abdominal tension and 
the desired effect was produced. Dr. AW Danforth procured in 
a desperate case the same effect by injecting one ounce and a half 
of soda, dissolved in a pint of water, and followed by the injection 
of a dessertspoonful of tartaric acid in a cupful of water. The thus 
suddenly generated gas untied the knot. 

Hsemorrhagia Intestinalis, Intestinal Haemorrhages, 
Malaena, 

Takes place in consequence of either — 1. Obstructed circulation of 
blood through the vena porta, as in the case of cirrhosis of the liver, 
diseases of the heart and lungs, compressions of the blood-vessels 
by large abdominal tumors; or, 2. Erosions or degeneration of the 
blood-vessels from intestinal ulcers during typhus, yellow fever, 
scurvy, etc.; or, 3. Lesions caused by corroding or cutting substances, 
wounds, etc.; or, 4. Suppressed normal, or habitual, bloody dis- 
charges, as menstrual or hemorrhoidal. A copious, internal 



HEMORRHOIDS, PILES. 547 

haemorrhage is characterized by sudden paleness, coldness of the 
body, collapsed features, weak pulse, fainting, fits of chilliness, 
and discharges of blood from the bowels. The discharged blood, 
when it comes from the upper portion of the intestines, is gener- 
ally dark and mixed with intestinal contents like tar. It is gen- 
erally red and fluid when it proceeds from the lower portions. 
The exact seat of the haemorrhage, however, cannot be deter- 
mined, as physical examination gives no hint whatever in regard 
to it. The bleeding may occur even within the stomach, as I 
have mentioned when I spoke of hrcmatemesis; and a black, tar- 
like appearance of stool is not a sign that it contains blood, as it 
may be colored by bile. This, however, may soon be settled. 
Throwing the passage into water it colors the water red when it 
contains blood; and when it contains bile the water is colored 
green or yellowish. 

THERAPEUTIC HINTS.— Compare the above-stated morbid con- 
ditions, which are the causes of the intestinal haemorrhage. 

As generally indicated, the most important remedies are Alum., 
Arsen., Carb. veg., Cbina, Eriger., Hamam., Ipec, Nitr. ac. Sul- 
phur. 

Haemorrhoids, Files, 

Consist of a dilatation of the hsemorrhoidal veins, to which be- 
long chiefly the plexus of veins lying in the submucous tissue of 
the lower part of the rectum, and in the adjoining subcutaneous 
connective tissue, also the venous radicles in the mucous mem- 
brane, the perirectal plexus, and the adjoining venous plexuses 
of the bladder, uterus, vagina, and the sacral canal. These 
dilated veins form tumors of different sizes, according to the 
amount of venous turgescence, from the size of a pea to that of a 
cherry or walnut, which sometimes encircle the entire anal open- 
ing like a bunch of grapes. When thus situated outside the anal 
margin they are called external, when within the anal margin 
internal haemorrhoids. 

There are usually longer or shorter intervals between these 
spells of turgescence, during which the patient feels comparatively 
free from hsemorrhoidal inconveniences. However, repeated 
attacks of turgescence will gradually change either the mucous 
membrane or the submucous tissue, and produce catarrhal swel- 



548 INTESTINAL CANAL. 

ling of the mucous membrane, or hyperplasia of the connective 
tissue, or atrophy of these tissues under the influence of the press- 
ure of the varices. The natural rugosities of the rectal mucous 
membrane become permanently thickened and inflamed, poly- 
pous growths are formed and associated with more or less pedun- 
culated tumors, resulting finally in suppuration and consequent 
purulent discharges — white or slimy haemorrhoids. 

The principal predisposing cause of piles seems to be the posi- 
tion of the hemorrhoidal veins, as the lowest branches of the 
abdominal vessels, and in their want of valves to sustain the re- 
turn column of blood in its course towards the vena porta. "When 
a retardation or stagnation by some means or other in this back- 
ward moving column takes place, it is obvious that its whole 
weight must press downwards upon its lowest branches, overfill- 
ing and dilating them. Such retardation of the refluent stream 
of blood may arise from different conditions : 

1. From tumors within the abdominal cavity, which press 
upon the veins of the rectum ; a gravid uterus, etc. 

2. From diseases of the liver, which obstruct the vena porta. 

3. From diseases of the lungs, by which its capillaries become 
either obstructed or destroyed. 

4. From diseases of the heart, by which the veins become over- 
filled with blood. 

5. From a general relaxation of the abdominal veins, in con- 
sequence of using too much wine, coffee, tea, or leading a seden- 
tary life. 

The fact, however, that frequently all members of the same 
family suffer with this complaint, seems in favor of the assump- 
tion that piles are of a hereditary nature, probably consisting of 
a congenital weakness or yielding of the walls of the hsemor- 
rhoidal veins. 

Symptoms. — As forerunners to their local appearance we ob- 
serve : fulness and pressure in the epigastrium, disturbed diges- 
tion, bloatedness of the abdomen, costiveness, dull pain in the 
small of the back, also in the head and nape of the neck, hypo- 
chondriacal disposition, disinclination to work, and especially to 
mental occupation, all symptoms which denote a disturbed action 
in the abdominal organs. After a shorter or longer duration 
of these symptoms, we find a gradual development of the local 
symptoms at the anus — the beginning of varicose veins, their 
gradual growth, their turgescence and their collapse, alternating 



HEMORRHOIDS, PILES. 549 

in longer or shorter intervals. Thus the whole complaint is of a 
slow and tedious nature, changing constantly from better to 
worse. The occasional spells of bleeding are frequently attended 
with a feeling of relief, though they do not better the morbid 
process itself in any way ; they become in some cases habitual, 
assuming a regular type of from three to four weeks intervals. 
In such cases the organism becomes so much accustomed to them, 
that when they are suppressed in consequence of mental emo- 
tions, or taking cold, or by external medical applications, etc., 
other disturbances set in, such as congestion of the head, lungs, 
stomach, liver, kidneys, etc., which may result in nosebleed, 
haemoptysis, bloody urine, apoplexy, etc. 

In consequence of the stagnation of the refluent stream of 
blood, which is caused by liver, heart or lung diseases, may arise, 
also, especially in older individuals, a varicose state of the veins 
of the neck of the bladder, of the uterus or vagina, causing 
haemorrhages from these organs, or slimy discharges, painful 
micturition, etc. 

"Dilatation of the sacral plexus is revealed by pain and a feel- 
ing of weight in the sacral region. When the communicating 
plexus of the spinal canal is affected, it may, by compressing the 
roots of the nerves, give rise to sensations of weight, numbness, 
formication, and pain in the lower extremities, or in the lumbar 
region, so as to simulate sciatica or a lesion of the cord itself." 
(Quinke.) 

The Prognosis depends upon its predisposing and proximate 
causes. Actual danger can only exceptionally arise from its 
local manifestation. 

THERAPEUTIC HINTS.— Aeon., bleeding piles; stinging and press- 
ure in anus ; abdomen feels full, with tensive, pressive and 
colicky pains ; bruised feeling in back and sacrum ; inflamma- 
tory stage. 

JEscul. hipp., protruding piles, purple, bleeding slightly, attended 
with constipation and a sensation as of sticks were in the rectum ; 
severe fulness and bearing down ; aching pain and lame feeling 
in the back. 

Aloes, protruding piles, like bunches of grapes ; hot and sore ; 
relieved by cold water; when urinating he has a feeling as 
though some liquid discharge from the bowels would take place 
at the same time ; much flatus with stool. 



550 INTESTINAL CANAL. 

Alum., stool hard, and of the shape of laurel -berries, attended 
with cutting pain in the anus, as if it were too narrow; succeeded 
by a jet of blood from the rectum, followed by soreness in and 
along the rectum ; perineum sweats and is tender to the touch. 

Amm. carb., varices protrude during stool, and without stool; 
they are moist, and with a pain as from excoriation ; discharge 
of blood during and after the evacuation ; burning pain in the 
rectum, itching of the anus. 

Ant. crud., tingling, itching, and burning of the varix ; mucous 
secretion from the rectum, staining the linen yellow; alternate 
constipation and diarrhoea. 

Apis, small protruding varices, which sting, burn and smart 
intolerably, making one very irritable and fidgety ; stool consti- 
pated, urine scanty. 

Arsen., varices, which burn like fire, particularly at night; fis- 
sures of the anus, with impossibility of voiding urine ; urine 
bloody; small of the back feels as if broken; impossibility of 
stooping ; burning in the skki and veins ; great weakness and 
restlessness ; useful in cases of drunkards. 

Bellad., bleeding piles with severe pain in the small of the back, 
as if it would break ; incarcerated varices from spasmodic con- 
striction of the sphincter ani, with great pain from the slightest 
touch ; on this account the patient must lie with the nates sepa- 
rated ; dysuria ; congestion of the head ; feverish restlessness. 

Calc. carb., profusely bleeding piles ; protruding ; painful when 
walking, better when sitting ; too early and too profuse menstru- 
ation ; habitually cold, damp feet; after suppression of the hemor- 
rhoidal flow, constant giddiness, especially on going up stairs ; 
heaviness and fulness of the head; swelling of the pit of the 
stomach ; palpitation of the heart ; offensive sweat on the feet, 
making the soles of them raw. 

Capsic, the varices bleed a long time ; the flowing blood causes 
a burning pain in the anus ; the stool is mixed with bloody mu- 
cus; there are drawing pains in the back and cutting pains in the 
belly. 

Carb. veg., protruding piles, blue, even suppurating, emitting a 
terrible smell ; burning in the rectum ; oozing of humor from 
the rectum; flatulence; congestion of the head, and nosebleed: 
after high living. 

Cascar., frequent and excessive bleeding from the rectum during 
and after hard, brown stool in large lumps, and without stool. 



HEMORRHOIDS, PILES. 551 

Caustic, varices large, painful, stinging; burning when touched, 
hindering stool; increased by walking and reflection; fistula ani. 

Chamom., bleeding haemorrhoids with colic; frequent urging 
and diarrhoea ; pain in the back, worse at night ; ulcerating fis- 
sures at the anus ; great restlessness, crying, screaming, tossing ; 
sweating ; angry, peevish and ill-humored. 

Colonic, with spasms of bladder and discharge of blood from it. 
(Stens, St.) 

Collins., flowing piles, incessant, though not profusely, or pro- 
truding piles without bleeding; sensation in the rectum as if 
sticks, sand or gravel had lodged there ; growing worse as even- 
ing approaches till late at night, better in the morning; consti- 
pation of the bowels and pain in the epigastrium, with loss of 
appetite ; or diarrhoea. 

China, bleeding piles ; burning and burning-itching ;' tingling 
in the anus, with creeping and itcbing extending into the ure- 
thra, attended with burning in the glans. 

Eriger., bleeding piles; hard, lumpy stools. 

Ferr. phosph., with catarrh of stomach and bowels. 

Graph.it, varices and prolapse of the rectum, even when there 
is no desire for stool, as if the rectum had lost its contractile power 
and had become paralyzed ; painful, burning cracks (rhagades) 
between the varices ; chronic constipation with hardness in the 
region of the liver ; stool hard, knotty with blood and slime ; 
scanty and delayed menses ; leucorrhoea like water. 

Hamam., profusely bleeding haemorrhoids, characterized by 
burning, soreness, fulness, and weight; at times rawness of the 
anus; the back feels as if it would break off; pricking pain, 
worse from pressure, from the wrist to the shoulder along the 
course of the superficial veins ; the same pricking pain in the re- 
gion of the heart ; scanty menses. 

Hepar, inflammation and suppuration of the hemorrhoidal 
tumors. 

Hydrast, when a small loss of blood is followed by excessive 
weakness. (H. F. Hunt.) 

Ignat, bleeding piles ; violent, shooting pains high up into the 
rectum ; prolapsus recti during stool ; cutting, tearing in the rec- 
tum, continuing for hours after stool ; for quiet people, or such as 
get easily excited and easily depressed. After confinement. 

Kali carb., in consequence of constipation with too large stools ; 
the hsernorrhoidal tumors swell and become large and very pain- 



OOZ INTESTINAL CANAL. 

fill; they bleed, especially during micturition, and emit slime 
afterwards; riding on horseback ameliorates the pain considera- 
bly for the time being. After confinement. 

Laches., protruding haemorrhoids, very painful; a stitching 
pain is felt to go through the haemorrhoidal tumors, especially 
during coughing or sneezing ; also at the critical age, with scanty 
menstrual flow. 

Leptand., frequently bleeding piles; constipation and distress- 
ing pain beneath the sacrum. 

Lycop., protrusion of yarices, painful when sitting; distention 
of the whole abdomen, and rumbling after stool ; cutting in the 
rectum and bladder ; long-continued pain after stool ; itching 
eruption around the anus, painful to the touch ; grayish-yellow 
color of the face ; depressed spirits ; frequent urging to urinate ; 
slimy or -reddish-sandy sediment in the urine. 

Mercur., large, bleeding piles during stool, which is watery; 
haemorrhage from the rectum during micturition ; falling of the 
rectum, which is black and bleeding; inflammation and suppu- 
ration of the haemorrhoidal tumors. 

Mur. ac, largely protruding piles, which look bluish and are 
.exceedingly painful to contact — even the sheet is insupportable ; 
prolapsus ani on passing loose stool during micturition. 

Natr. mur., varices, painful, stinging, and humid ; protrusion of 
the rectum ; smarting and beating in the rectum ; burning at the 
anus ; herpes about the anus ; herpes on the boundaries of the 
hair in the nape of the neck ; cutting pain in the urethra after 
micturition. 

Nitr. ac, bleeding piles, protruding after each stool ; the sharp- 
cutting pain in the rectum lasts for hours after an evacuation, 
and is much worse after a loose stool. 

Nux vom., all sorts of piles after purgative medicines and ex- 
ternal and internal allopathic treatment ; in persons of sedentary 
habits, or addicted to the use of coffee, wine, liquors, spices, etc. : 
ineffectual urging ; constipation ; headache ; sleeplessness early 
in the morning ; hypochondriac mood ; fissures of the anus, 
with great sensitiveness of the rectum. 

Petrol., burning and stitching in the anus and rectum ; scun 
on the border of the anus; titillating and smarting; itching 
herpes on the perinamm. 

Phosphor., varices protrude during emission of flatus ; mucous 
discharges from the anus, which is constantly open ; discharge 



HEMORRHOIDS, PILES. 553 

of dark, coagulated blood ; vertigo, especially on looking up or 
down. 

Phosph. ac, bleeding piles, with intolerable pain in sitting. 

Podoph., piles and prolapsus ani, with diarrhoea of long stand- 
ing; worse in the morning; or constipation with flatulence and 
headache. 

Pulsat, blind and flowing haemorrhoids ; discharge of blood 
and slime with the stool ; colicky pain ; painful pressure upon 
the hemorrhoidal tumors; backache; fainting spells ; mild, gen- 
tle and tearful disposition ; dryness and bad taste in the mouth 
every morning; no thirst. 

Ratan., protrusion of the varices after hard stool, with straining 
and violent pressing in the rectum ; burning at the anus before 
and during a diarrhceic stool ; fissures of the anus, with great 
sensitiveness of the rectum. 

Rhus tox., sore, blind haemorrhoids protruding after every stool; 
drawing in the back from above downwards, with tension and 
pressing in the rectum, as if everything would come out ; labor- 
like drawing towards the uterus, when standing; pain in the 
small of the back, as if bruised, when lying or sitting still ; going 
off when moving about. 

Sepia, protrusion of piles and rectum, even after soft stool ; 
worse after drinking milk; continual straining pain in the rec- 
tum; difficulty of urinating, especially in the morning; a feeling 
as if drops came out of the bladder, which is not the case; heat, 
burning and swelling of the anus; the varices become hardened; 
oozing of moisture from the rectum; soreness between the but- 
tocks. 

Staphis., intense pain in the back and through the whole pel- 
vis; enlargement of the prostate gland. (Preston.) 

Silic, inflammation and suppuration of the hemorrhoidal tu- 
mors. 

Sulphur, all sorts of piles; constant ineffectual urging to stool; 
or thin, bloody stool, worse in the morning, with soreness of the 
anus, or single violent stitches in the rectum, also between stools, 
arresting the breathing and causing him to start; prolapsus ani 
during stool, particularly when hard; tensive pain and stiffness 
in the small of the back, as if the parts were too short; inability 
to stand erect; burning micturition. After suppression of habit- 
ual bleeding: congestion of the head; dizziness; palpitation of 
the heart; pain in the pit of the stomach, with difficulty of 



554 INTESTINAL CANAL. 

breathing; loss of appetite; sudden hunger, with faintness before 
dinner; sleepiness through the day, and sleeplessness at night. 

Thuja, the haemorrhoidal tumors are painful when touched 
ever so slightly; sycosis. 



Flatulency, Bloatedness, Meteorism of the Abdomen. 

We mean by these terms an abnormal collection of gas in the in- 
testinal canal. It may be caused: 

1. By certain kinds of food, such as not well-fermented beer, 
sweet cider, fresh bread, green peas, unripe fruit, cabbage and 
the like. 

2. By a morbidly changed condition of the digestive juices, which 
cause fermentation of the intestinal contents. . 

3. By a relaxed state of the muscular coat of the intestines, in con- 
sequence of which the contents of the bowels are not properly 
moved forwards, and become decomposed into gaseous sub- 
stances. For this reason we frequently observe meteorism in 
severe cases of typhus, pneumonia, acute exanthematic and puer- 
peral fevers, peritonitis, after the abuse of purgative medicines, 
in diseases of the brain and spine, also in hysteria and hypo- 
chondria. 

4. By mechanical obstructions of tin intestinal caned, like strangu- 
lated hernia, intussusceptions and twistings of the gut around its 
own axis. 

Symptoms. — The abdomen appears bloated, puffed out. feels 
either elastic, or more or less inelastic and hard, according to 
the degree of compression of the gas within. Percussion gener- 
ally yields a tympanitic sound, unless there be a greater tension 
of the gas within than of the external air, in which case the per- 
cussion sound is not tympanitic, and may be even dull. Auscul- 
tation reveals here and there gurgling noises, and even the me- 
tallic tinkling may be heard when the fluid contents move within 
the expanded guts. 

Such abnormal expansion of the intestines forces the liver, 
stomach and lungs higher up into the thoracic cavity, causing 
oppression, dyspnoea, palpitation of the heart, anxiety, fainting 
and congestion of the head. The expansion downwards causes 
pressure upon the bladder, difficult urination, pressure upon the 
rectum, and frequent desire for stool, and pressure upon the 
uterus. This abnormal collection of gas is frequently associated 



FLATULENCY, BLOATEDNESS, METEORISM. 555 

with spells of violent colic, loss of appetite, nausea, etc. Belch- 
ing, or the passing off of flatus, often gives great relief. The gas 
generated consists mostly of carbonic acid, or hydrogen, or sul- 
phuretted hydrogen gas. 

It is obvious that the Prognosis depends entirely upon the 
cause, of which meteorism is the consequence. It is of little 
consequence if produced merely by improper food, or the im- 
proper condition of the digestive juices. It becomes a more 
serious symptom when caused by a relaxed state of the muscular 
coat of the intestines, and is most serious in cases of intestinal 
obstruction. 

THERAPEUTIC HINTS.— Carb. veg., much belching, sour and 
rancid ; bloatedness of stomach and bowels ; oppression of the 
chest; palpitation of the heart; consequences of high living. 

China, distention of the abdomen ; oppression of the stomach ; 
eructations, especially after eating; great fermentation in the 
bowels ; after new or sour beer and fruit. 

Chamom., attended with severe colic; the abdomen is swollen 
like a drum ; the gas passes off constantly, but in small and in- 
sufficient quantities. 

Laches., eructations of air affording relief; distended stomach; 
incarceration of flatulence. 

Lycop., constant rumbling and gurgling of wind in the bowels, 
especially in the left hypochondrium ; incarcerated flatulence, 
which bears downwards upon rectum and bladder, causing a 
number of bad feelings. 

Nux vom., pressure towards the chest and head ; oppression of 
the chest; constipation, with constant, ineffectual urging; after 
spirituous drinks, coffee, condiments, etc., in consequence of se- 
dentary life. 

Pulsai, especially in consequence of spoiled stomach from eat- 
ing fat things, pastry, warm cakes, fruits, etc. 

Besides, compare Gastric and Intestinal Catarrh, Constipation 
and Colic. 



Colica, Enteralgia. 

We understand by this term a paroxysmal pain in the abdomen 
of a purely neuralgic character without any discoverable patho- 
logical change within the structure of the intestines, although it 



556 INTESTINAL CANAL. 

may attend different morbid processes which consist of such 
pathological changes. The Causes are numerous ; they may be 
classed under the following heads : 

1. Such as are dependent upon anomalies of the intestinal con- 
tents: abnormal quantity or quality of food, colica saburralis; or 
abnormal development of gas, colica flatulenta, wind, colic; or accu- 
mulation of hard feces, colica stercoracea; or foreign irritating 
bodies, like worms, colica ferminosa ; or metallic bodies, like lead, 
colica saturnina; or copper, colica seruginosa. 

2. Such as are dependent upon a disturbed innervation, either — a. 
Primarily within the great centres of innervation themselves, 
from mental emotions, in case of hysteria or hypochondria and 
spinal diseases — colica nervosa; or, b. Secondarily, in consequence 
of diseases of other organs, which may cause a pain in the bowels 
sympathetically on the principle of "reflex action." Hence, 
authors speak of colica hepatica when the liver, of colica uterina 
when the womb, of colica renalis when the kidneys, are thought 
to be the starting point of the colic. Still, we ought to remem- 
ber that in such cases the pain may not be an intestinal colic at 
all, but merely an irradiation from the primarily affected parts. 

3. Such as are dependent upon structural changes in the intes- 
tines, among which we may reckon colicky pains in dysentery, 
catarrhal affections, typhlitis, hernia, intussusception, strangula- 
tion, twisting, etc. There is also a kind of colic produced by 
taking cold, especially of the feet and abdomen, and which is 
called colica rheumatica. 

Symptoms. — 1. Pain. It is of a crampy, severe griping, or 
twisting nature, coming and going in paroxysms, either in the 
umbilical region or in the side of the abdomen; oftentimes shift- 
ing from one place to another. External pressure sometimes 
gives relief and sometimes aggravates the pain ; in other cases it 
shows no influence. External application of warm things re- 
lieves in a majority of cases, whilst cold things almost always 
aggravate the pain. 

2. Polling and gurgling in the abdomen, occasioned by irregular 
contractions of the intestines and the moving of their fluid and 
gaseous contents, which may be felt by the examining hand. 

3. Bloatedncss of the abdomen where there is a great collection of 
gas; or contraction of the abdomen, especially in lead colic. 

4. Constipation; it is only in rare cases that colic is attended 
with diarrhoea. 



COLICA, ENTERALGIA. 557 

5. Nausea, vomiting and belching, 

6. Cold perspiration and extremities ; small pulse. 

7. „ 1 n. nous, frightened expression of countenance, contraction of eye- 
brows, and compression of lips. 

8. Great restlessness; the patient tries all possible positions to 
obtain relief — now lying on tbe stomach, now drawing up the 
limbs, now bending and pressing the abdomen against a hard 
object, a chair, table, or bed-post; now sitting down, now walk- 
ing about, now trying to evacuate the bowels, etc. In some cases, 
however, the slightest motion increases the pain. 

The spells usually last some hours, in some cases longer. 

"Wind colic ceases as soon as the incarcerated gas finds vent and 
.passes off. 

Colic from indigestion is relieved by vomiting or diarrhoea ; 
colic from hard feces by a sufficient evacuation from the bowels. 

Colic from taking cold is always relieved by a general warm 
perspiration. 

As there are so many causes for, and so many different affec- 
tions with which colicky pains may be associated, it is absolutely 
necessary in each particular case to make as close an examina- 
tion as possible, in order to find out what lies at the bottom of 
the painful affection. 

Colic from indigestion, or colica saburralis, is brought on either 
from overloading the stomach or from improper or unhealthy 
food. 

Here are indicated — 

Nux vom., after coffee, brandy, large meals. 

Pulsat, after fat food, pastry and flatulent food. 

Ipec, after sour and unripe fruits and salads. 

Arsen., after ice-water and ice-cream. 

Flatulent colic is characterized by distention of the abdomen, 
gurgling and rolling in the bowels, or pressure upwards towards 
the thoracic cavity, causing pain there and shortness of breath, 
or pressure downwards upon bladder and rectum. 

Here are indicated — 

Bellad., if associated with congestion of the head. 

Carb. veg., when there is a great deal of sour and rancid belch- 
ing, without much relief. 

Chamom., when the abdomen is distended like a drum, and 
wind passes off only in small quantities without relief. 

Lycop., in cases of habitual costiveness and great pressure 



558 INTESTINAL CANAL. 

downwards upon rectum and bladder, and gurgling under the 
left hypochondrium. 

Nux vom., when there is great pressure upwards toward the 
thoracic cavity. 

Opium, when there is great pressure downwards upon bladder 
and rectum, without any passing off of feces, gas or urine. 

Rheumatic colic follows upon suddenly taking cold, getting 
wet, etc. 

Here are indicated — 

Aeon., after suppressed perspiration, exposure to sharp north- 
west wind. 

Coloc, cutting, pinching, contracting pain, with hot or cold 
skin, irritated pulse and a disposition to double up and press, 
hard upon the abdomen. 

Dulcam., after taking cold ; the griping is attended with nausea 
in the stomach and followed by diarrhoea. 

Pulsat, after getting the feet wet. 

Rhus tox., after getting wet all over. 

Nervous colic is a consequence of morbid innervation arising 
suddenly, sometimes without any known causes, showing no 
abjiormity in the abdominal cavity. 

Here are indicated — 

Coloc, after indignation. 

Bellad., clawing around the navel ; better from pressure. 

Ignat, after grief and fright. 

Opium, after sudden fright. 

Plumbum, contracted abdomen. 

Lead colic — poisoning by lead. Bluish-gray line along the 
gums; retracted abdomen; pain lessened from external pressure; 
obstinate costiveness; slow pulse. 

ANTIDOTES.— Opium, Platina, Nux vom., Alum., Ant. crud.. Coccul., 
Arsen., Bellad., Podoph., Zincum. 

Copper colic, poisoning by copper. Distended abdomen; pain 
worse from slightest touch ; nausea; vomiting; tenesmus. 

ANTIDOTES.— Hepar, Nux vom., BeUad. 

All other secondary forms of colic are mere attendants upon 
other disturbances, which either have been considered already, 
or will be considered later. 

SPECIAL HINTS.— Aeon., intolerable, cutting pains in the belly, 
so violent that he screams, tosses about, and is almost beside 
himself; after taking cold ; menstrual colic. 



COLICA, ENTERALGIA. 559 

Alum., lead colic, with dyspnoea, or pressing down in the groins 
like hernia. 

Arsen., pains in the whole abdomen, excessive; worse at night, 
after eating and drinking; better from warm application; with 
vomiting, or diarrhoea, or costiveness; great anguish, lamenta- 
tions, tossing about; internal restlessness, which does not allow 
one to lie still; despair of life; after the use of ice-water, ice- 
cream; bad sausages, cheese; lead poisoning. In colic after 
severe burns. 

Asaf., distention of the abdomen, with severe pain and a feeling 
as though something were rising from below upward into the 
chest and throat; during the height of the paroxysm, fainting; 
pain better from external pressure; in hysteric and hypochon- 
driac persons. 

Aurum, painful accumulation of gas below the left ribs, causing 
a stitching pain there; coming on even after eating the simplest 
food. 

Bellad., during the pain the transverse colon protrudes like a 
pad all the way across the belly; while sitting or standing and 
walking, much worse, with a feeling as though the intestines 
were loose and dragging downwards; external pressure and 
bending double relieves somewhat; protrusion in the inguinal 
region as thick as a finger, which, when pressed upon, disappears 
Avith a gurgling sound; pain below the navel, as though a portion 
of the intestines were seized with the nails, clawing it together; 
thin purulent stool; congestion of the head; copper colic. The 
pain comes suddenly and disappears suddenly. 

Bryon., after taking cold; cutting, lancinating pain in the 
abdomen; worse from motion and drinking cold water; bowels 
constipated; feces hard, as if burnt; tongue coated, white, dry, 
without thirst; or else great thirst. 

Calc. carb., severe spasms in the intestines, especially in the 
evening and at night, with coldness of the thighs; feeling of 
coldness in the abdomen; enlargement and hardness of the 
abdomen, particularly in teething children ; diarrhceic, clay-like 
stools, smelling sour or fetid; sweat on the head. 

Carb. veg., fulness and distention of the abdomen, with a feeling 
as though it would burst; squeezing and pressing in the left side 
of the epigastrium, or in the region of the bladder; oppression of 
the chest; belching, tasting sour and rancid; headache; chilliness 
over the back; hypochondriac mood; worse from eating, if ever 



560 INTESTINAL CANAL. 

so little ; better from emission of flatus or hard stool ; colic from 
riding in carriage. 

Caustic, crampy colic of a chronic character; pain from the 
stomach through to the back, up into the chest, down into the 
abdomen; belching; rumbling in the bowels; obstinate consti- 
pation; tongue coated whitish on both sides. 

Chamom., flatulent colic; the abdomen is distended like a drum, 
or the wind presses here and there against the abdominal walls, 
with a feeling as if it would pierce through ; or the patient has a 
feeling as if the whole abdomen were hollow, with continual 
rolling in the bowels and blueness around the eyes; or the 
excessive pain simulates a sensation as if the parts were rolled up 
into a ball; vomiting; diarrhoea, green and slimy; or continual 
passing of small quantities of flatus without relief; great rest- 
lessness, anxiety; sticky or hot perspiration; after chagrin, or 
taking cold. Very irritable mood. 

China, distention of the abdomen, with pressing under the short 
ribs; rumbling and cutting pain in the bowels; worse at night; 
brought on by eating fruit or drinking new beer; after exhaust- 
ing illness, loss of vital fluids, profuse perspiration ; gall-stones. 

Chin, sulph., flatulent colic of an intermitting type. 

Coccul., flatulent colic, about midnight, with incessant formation 
of flatulence, distending the abdomen, going off without relief, 
and obliging to turn from side to side; belching relieves; the 
pain is .most severe in the epigastric, umbilical and right iliac re- 
gion; nausea, vomiting; yellow face; cold perspiration, anxiety 
and restlessness. 

Coffea, excessive pains with anguish, great nervousness, loud 
crying and grating of teeth; suffocative fits; coldness of limbs; 
convulsions. 

Colonic, great distention of the abdomen ; also when the abdo- 
men is empty, aggravated by eating ; the stomach feels icy cold ; 
after flatulent food. 

Coloc, all sorts of violent pains, mostly in the umbilical region, 
or from the sides concentrating in the middle ; the patient doubles 
up, or seeks relief by pressing the belly against the bed-post or 
any other hard object, or by lying on the belly ; likewise a tight 
cramp-like pain in the left iliac and inguinal region, which is 
worse after (not during) external pressure, especially observed in 
women after excess in venere; after indignation ; abuse of opium; 
a cup of coffee generally relieves the pain for a while. 



COLICA, EXTERALGIA. 561 

Cuprum, violent spasms in the abdomen and in the upper and 
lower limbs, in spells; cutting pain in umbilical region, as if a 
knife were thrust through into the back ; screams as though he 
were being killed, throwing himself upon the floor; singultus 
and stercoraceous vomiting. 

Diosc, remitting, griping pain in the epigastric and umbilical 
region ; or severe pain in left iliac region, running upwards to 
left kidney, better from crouching together with the hands clasp- 
ing the knees ; or pain in a small spot which feels, as if it were 
drawn forcibly upwards and backwards towards the spine. Con- 
stant desire to defecate and urinate without accomplishing much. 

Dulcam., colic when the weather changes suddenly from warm 
to cold ; griping in the bowels, with nausea, and coldness in the 
small of the back ; diarrhoea. 

Hyosc, colic as if his abdomen would burst, he presses his fists 
into his sides; spasmodic cutting, vomiting, belching, hiccough- 
ing and screaming. 

Ignai, periodical abdominal spasms, particularly at night, wak- 
ing out of sleep, with stitches running up into the chest and to 
the sides ; in sensitive and hysteric women. 

Ipec, colic of children, with diarrhoea, uneasiness, screaming, 
and tossing about ; after acid or unripe fruit, beer, etc. 

Iris, colic of infants with flatulency and constipation, where 
Chamom., Coloc. and Nux vom. bad failed. 

Kali carb., colic, as if the intestinal canal were full of water. 

Lycop., bloatedness in consequence of incarcerated flatulence 
and constipation, with urging to stool ; a feeling as if the abdo- 
men must burst; belching without relief; passing flatus down- 
wards relieves ; renal colic, where the pain is felt along the 
ureters into the bladder, especially in the right side. 

Magn. phosph., intermittent pain, relieved by bending double, 
by rubbing, and by external warmth and eructations. 

Mercur., colic occasioned by the cool evening air, with diarrhoea, 
chilliness and shuddering. 

Nux vom., flatulent distention of the abdomen, with pressure up- 
wards into the chest, and downwards upon the rectum and blad- 
der; would like to belch, but cannot; constant urging to stool 
without effect, and frecment desire to make water; wind colic, 
hemorrhoidal, renal and lead colic. 

Opium, when flatulence accumulates in the upper portions of 
the bowels, causing a distention of the abdomen, especially in 
36 



562 INTESTINAL CANAL. 

the umbilical region, with antiperistaltic motion, belching and 
vomiting ; the bowels seem perfectly closed, but there is a con- 
stant urging to stool and to urinate; the pain is cutting, pressive 
and twisting ; painter's colic. 

Oxal. ac, from eating sugar. 

Piper meth., agonizing pain, with tossing, twisting and writh- 
ing; patient driven irresistibly to change position, without re- 
lief; better for a while when his attention is absorbed by some- 
thing else. (Hiller.) 

Platina, painter's colic ; pain in umbilical region, extending 
through into tbe back ; the patient screams and tries to relieve 
the pain by turning in all possible positions. 

Plumbum, frightful pain, particularly around the umbilicus; the 
umbilicus drawn in towards the spine; obstinate constipation. 

Podoph., cramps in the bowels, with retraction of the abdominal 
muscles, or crampy drawing of the muscles into lumps and knots; 
lead colic. 

Pulsat, colic worse in the evening and at night; pale face; 
white tongue ; no thirst ; wants to uncover ; grayish diarrhoea ; 
tearful disposition. From eating fat and greasy food. 

Rheum, in infants with sour diarrhoea; the child smells sour 
all over. 

Rhus tox., worse at night, and when being quiet ; better from 
moving about, or lying on the stomach. 

Sabad., sensation as if a ball of thread were moving and turn- 
ing rapidly through it. " Oh, my bowels ! it runs like a wheel ! '* 

Sepia, boring, burning pain, with great distention and sensitive- 
ness of the abdomen ; anxiety; typically recurring towards even- 
ing; scrofulous persons. 

Stammm, stitches from both sides through the abdomen and 
through the hips; worse from slightest motion or touch, and 
when lying on right side; vomiting of water when smelling any 
kind of cooking. 

Sulphur, spasmodically contractive colic, extending into the 
chest, the groin, and the genital organs ; from piles ; from flatu- 
lence ; from eating sweet things ; relieved by sitting bent : psoric 
individuals. 

Tart, emei, violent colic, as if the bowels would be cut to pieces: 
violent cutting and labordike tearing from above downwards. 
across the groin through the thighs down to the knees: nausea: 
accumulation of water in the mouth ; shifting of flatulence, with 
rumbling in the bowels and diarrhoea. 



TUBERCULOSIS INTESTINALIS. 568 

Thuja, hemorrhoidal colic, with very acute and violent pain in 
the lower bowels; much flatus, with or without stool; feces hard 
or fluid and scanty; when fluid there is a sensation in the rectum 
as if boiling lead were passing through. 

Veratr., abdomen swollen and very sensitive; violent pinching 
pains; no discharge of flatus either up or downwards; the intes- 
tinal canal seems closed; nausea; inability to swallow; cold per- 
spiration; anxiety; restlessness; after eating fruit or vegetables. 

Zincum, flatulent colic, worse from wine, towards evening, and 
when at rest; loud rolling and rumbling; retraction of the abdo- 
men; hot, moist flatus passing off without relief; lead colic. 

Tuberculosis Intestinalis, Consumption of the Bowels. 

Tubercles form not only in the lungs; they are as well de- 
posited in the mucous and submucous membrane of the ilium, 
especially in Peyer's patches and the solitary glands, in the 
colon, the caecum, rarely, however, in the jejunum and duode- 
num. The tuberculous material, wherever deposited, consists 
either of yellowish, cheesy masses, or of grayish, half-transparent, 
so-called miliary granules, which, by a gradual dissolving pro- 
cess, produce tuberculous ulcers. 

Intestinal tuberculosis is rarely a primary disease, but gener- 
ally part and portion of — 

1. Pulmonary consumption, to which it adds the finishing blow. 
Iu some cases, however, intestinal tuberculosis seems to so pre- 
dominate over the pulmonary complaint that the latter is con- 
cealed by the abdominal trouble. 

2. In other cases intestinal tuberculosis attends acute miliary 
tuberculosis, a form of blood-poisoning, which, under the symp- 
toms of typhus, deposits a great number of fine granules in dif- 
ferent organs and tissues. It cannot be distinguished from 
typhus; nor from tubercular meningitis, if its deposition inflames 
the pia mater. 

Lastly, intestinal tuberculosis may be part and portion of tu- 
bercular formations in the peritoneum, the mesenteric glands 
and the retroperitoneal glands, all of which are difficult to define. 

The Symptoms are not at all prominent or characteristic, only 
when the tubercles commence to soften in the last stage, an ob- 
stinate diarrhoea is one of the most prominent symptoms. With 
it are associated great loss of strength, night-sweats, and partial 
oedema; the patients finally die with the signs of marasmus. 



5G4 INTESTINAL CANAL. 

Obstinate diarrhoea, in conjunction with pulmonary tuberculo- 
sis, suggests the following remedies: Arg. nitr., Arsen., Bryon., 
Baryt. earb., Calc. carb., Calc. phosph., Carb. veg., China, Ferrum, 
Hepar, Mercur., Nitr. ac, Phosphor., Phosph. ac, (Plumbum) 
Pulsat., Sulphur. Compare Consumption. 

Cancer of the Intestines 

Appears either in the form of scirrhus or fibrous cancer, or as 
medullary cancer (which is of a softer, marrowdike growth), or as 
alveolar cancer (which is of a jelly dike nature, but of rare occur- 
rence). Compare Cancer of the Stomach. It originates primarily 
in the submucous and mucous coats of the intestines, or reaches 
over secondarily from a cancer of the stomach, or of the perito- 
neum, the liver, ovaries, uterus, or. other neighboring organs. 

Primary cancer is found most frequently in the rectum; also 
often in the flexura sigmoidea; very rarely in the remaining 
parts of the intestinal tube. As it grows, it causes a swelling or 
tumor from the size of an egg to that of a fist; and by its growth 
gives rise to intestinal obstruction. Nevertheless its diagnosis 
may, in certain cases, be one of great difficulty. It may be sug- 
gested by partial intestinal obstruction; rarely by total obstruc- 
tion; also by the general symptoms of cancer cachexia. Or in 
younger individuals it may cause intestinal obstruction alone, 
without these general symptoms of cancer-cachexia. Or it may 
produce merely the general cancer-cachexia without any sign of 
intestinal obstruction; but in place of it diarrhoea, colicky pain, 
flatulency, etc., the dejections containing blood, a gangrenous, 
stinking fluid and pus. 

The main points of diagnostic importance are these: The pres- 
ence of an uneven, potato-like tumor; the slow but steady devel- 
opment of intestinal obstruction; the peculiar dry and ash-col- 
ored skin; the fast wasting away in strength and flesh: and the 
age of the patient, as cancer very rarely appears before the age 
of forty. 

Cancer of the rectum is the most frequent in occurrence. At the 
beginning of its development, when it causes a pressure upon, and 
a consecutive swelling of the hemorrhoidal veins, with occasional 
bloody discharges, and pain from the os sacrum down into the 
thighs, it is most easily confounded with haemorrhoids. Later. 
however, the obstruction of the rectum becomes more apparent 



POLYPUS RECTUM — FISSURA ANI. 565 

by the form of the discharged feces, which appear pressed, flat- 
tened, angular, or pass off in small, hard nuts, like sheep-dung. 
Manual examination reveals now a knotted tumor, which encir- 
cles the gut like a ring. In its still further advanced stage this 
tumor suppurates, and the bursting of blood-vessels may occasion 
profuse haemorrhages. We sometimes observe in combination 
with it indurated inguinal glands; and I have seen a case where 
hard scirrhous infiltrations existed disseminated through the 
glutieus muscles. 

Its Prognosis is, like that of all cancers, very discouraging. 
Death occurs either in consequence of ilius, or peritonitis after 
perforation of the gut, or exhaustion. 

By means of the following remedies we may succeed in alle- 
viating much suffering: 

Apis, Arsen., Bellad., Carb. an., Carb. veg., Clemat., Cannab., 
Graphit., Hepar, Hydrast., Kreosot., Laches., Phosphor., Phosph. 
ac, Rhus tox., Sepia, Silic, Sulphur, Thuja. 

Polypus of Rectum. 

The follicular or soft polypus occurs generally in childhood, 
very rarely in the adult, is attached to the mucous membrane 
by a narrow peduncle and usually protrudes in children after a 
stool, resembling a small strawbeny ; it causes no pain but may 
produce bleeding sufficient to weaken the patient. 

The fibrous or hard polypus is pear-shaped, with a peduncle 
more or less long and thick, protrudes if low down or attached 
to a long peduncle, causes some slimy discharge, but rarely 
bleeds, produces frequently the sensation of unrelief after stool 
and its peduncle may become girt by the sphincter, which 
causes great pain. 

THERAPEUTIC HINTS.— Calc. carb. and phosph. are the main 
remedies. Ligature is the best surgical means. 

Fissura Ani. 

An anal fissure consists of an abrasion or ulcer usually at the 
posterior part of the lower circumference of the rectum, although 
it may occur in any other part of this portion of the anal mucous 
membrane, which here forms folds or pouches. When looked at 



56G INTESTINAL CANAL. 

without distending the rectum, the lateral edges only heing pre- 
sented to view, the ulcer appears like a fissure, but is in reality an 
abrasion or a superficial ulcer. On defecation its surface is irri- 
tated, exciting spasm of the sphincter muscle, and causing sharp, 
cutting, burning and straining pains which last at times for two 
or three hours after stool. This trouble occurs usually in middle 
life and is more frequent in women than in men. 

THERAPEUTIC HINTS.— Aloes, when complicated with piles. 

Alum. P. S., ulceration of rectum, even fistula. 

Arum triph., with retention of urine. 

Coloc, burning, sticking and excoriated pain in the anus, with 
discharge of moisture from the rectum ; frequent pressure at the 
anal sphincter, which ceases on the escape of some mucus. 

Graphit., severe cutting pain during evacuation, followed by 
constriction and aching contraction for several hours, especially 
severe at night. 

Ignat, haemorrhoids; moderate effort at stool causes prolapsus 
recti; after stool stitching pain upward into the rectum: recurring 
pains in the anus of soreness and constriction. 

Mtr. ac, very painful, especially after loose stool. 

Nux vom., with constipation and great sensitiveness of rectum. 

Pgeon. off., burning and biting several hours after stool, prevent- 
ing sleep; must walk the floor nearly all night: exudation of 
offensive moisture. 

Platina, with crawling and itching in anus every evening, fre- 
quent urging with scanty stool, painful sensation of weakness. 

Ratan., burning in ano before and several hours after stool with 
protrusion of varices: burning in urethra during urination. 

Rhus tox., with periodical profuse bleeding from anus. 

Silic, great pain half an hour after stool, lasting several hours. 

Besides compare: Amm. carb., Caustic, Gratiola, Mezer., Natr. 
mur., Phosphor., Plumbum, Sabad., Sepia, Thuja. 

Fistula Recti 

is produced by the forming of an abscess in the loose areolar 
tissue around the lower part of the rectum. After bursting out- 
side near the anus its walls contract and become fistulous, form- 
ing a blind external fistula. If the suppurating process has at the 
same time opened a way through the rectal parieties into the 



FISTULA RECTI. 5G7 

bowel, it is a complete fistula. Blind internal fistula, in which an 
opening leads into the bowel without an external orifice, are 
rarely met with, though it may happen that the original ulcerated 
opening in the rectum is so large as to allow the matter from the 
abscess in the areolar tissue to escape readily into the bowel 
without the necessity of burrowing its way through to the 
outside. Sometimes the sinuses are tortuous or pass in different 
directions and there may be more than one internal opening. 
At other times there is an external orifice on each side of the 
anus which lead to the back of the rectum and communicate 
with the gut at this part by a single orifice, so as to form a sort 
of horseshoe fistula. In phthisical subjects a fistula may originate 
in consequence of tubercular ulceration and perforation of the 
bowel. 

The forming of a fistula is always attended with pain, heat, 
redness and swelling before it breaks externally. Later, after 
the subsidence of inflammation and tenderness, it remains a 
constant annoyance by its discharging, more or less copiously, 
a thin purulent fluid when coming from a blind external fistula, 
or a brownish fluid from an admixture of faeculent matter, 
when it issues from a complete fistula. At times the discharge 
becomes so thin and scanty that it appears as if the sinus were 
healing, when a fresh irritation again disappoints the sufferer. 

THERAPEUTIC HINTS.— The old school knows nothing but the 
knife, and the modern view that all such affections are but of a 
local nature, does not make them hesitate in using it, notwith- 
standing the fact that a large percentage of those operated on in 
a short time after succumb to tuberculosis of the lungs. 

Many anal fistules have been cured by the sole use of internal 
remedies, and others have been so decidedly relieved, that so 
doubtful a relief as operation could afford, was never afterwards 
craved for. The remedies here needed are : 

Alum. P. S., ulceration of the rectum, with painful excrescences 
and fetid, ichorous discharges. 

Arseii., despondent; chilly up and down the back ; relief from 
heat ; large purple swelling on right gluteal muscle. 

Berber., great soreness and pain throughout the entire back, 
from the sacrum to the shoulders, worse from exertion. 

Calc. sulpfr, Schiissler. 

Hydrasi, with constipation, piles and ulceration. 



568 INTESTINAL CANAL. 

Silic, aching, beating, throbbing in lumbo-sacral region ; occa- 
sional swelling in perineum discharging blood and pus ; consti- 
pation, stool slips back after much effort. 

Thuja, blind external fistula with cauliflower excrescences at the 
verge of the anus; offensive perspiration around the parts affected. 

Besides compare: Calend., Caustic, Ignat., Nux vom., Petrol., 
Sepia, Staphis., Sulphur. 

Prolapsus Recti. 

The protrusion of the hypertrophied mucous membrane, often 
observed in haemorrhoids, is not a true prolapsus. This, on the 
contrary, consists of a real falling down and out of all the coats 
of the rectum, is in fact an eversion of the gut, similar to intus- 
susception, with this difference : that the falling portion of the 
intestine becomes uncovered and projects externally, while in 
intussusception it becomes invaginated into that portion of the 
intestine which is just below it. The extent of the protrusion 
varies greatly, from an inch to six inches or even more. When 
not constricted by the sphincter it has the usual florid appear- 
ance; when strangulated it appears livid, purple and tumid from 
congestion. After long exposure the mucous membrane becomes 
thickened and granular and sometimes ulcerated. 

Prolapsus recti is most frequently observed in children in con- 
sequence of protracted diarrhoea ; less often is it found in adults, 
and then oftener in women than in men, in consequence of a 
weakened state of the sphincter, after child-bearing, etc. The 
protrusion takes place usually during stool, sometimes after any 
movement, even when standing. The gut may remain constantly 
protruded, being fixed so as not to admit of replacement, In 
some cases the protruded portion has even sloughed off. 

THERAPEUTIC HINTS.— Bellad., the protruded bowel looks bright 
red ; during dentition. 
Ferrum, (R. T. Cooper). 
Ignat. has helped most frequently. 
Indigo, (Schussler). 

Mercur., when there is great straining. 
Mur. ac, when urinating. 
Nux vom., frequently in children. 
Podoph., with morning diarrhoea. 



PROCTALGIA — INTESTINAL WORMS. 569 

Ruta, frequent, lumpy, slimy stools, at times bloody ; feces often 
escape while bending over; much flatus; prolapsus always at 
stool, sometimes without stool. (Mera.) 

Sulphur, worse on standing; morning diarrhoea; after easy 
stool ; weak, scrofulous children. 

Besides : Apis, Arsen., Calc. carb., Carb. veg., Hamam., Lycop., 
Mezer., Phosphor., Sepia, Silic, Thuja. 

Proctalgia, 

Or neuralgic pain in the rectum, here oftentimes as violent as in 
other places, is relieved by Kali carb., when the pain is stitching 
and pressing. Phosphor., in violent spasmodic pains, driving the 
patient about. 

Intestinal Worms, Entozb'es, Helminthes. 

Of the twenty-one intestinal parasites, three are infusoria, nine 
belong to the tape-worm class, two to the leech tribe and seven to 
the round worms. Of these only the following deserve a closer 
mention in this place. 

1. Oxyuris vermicularis, the thread, seat, or pin-worm, is found 
in the intestine, from the jejunum down to the anus; the young 
animals, in their various stages of development, and the mature 
males chiefly inhabit the small intestine; the pregnant females 
seem to prefer chiefly the caecum as their habitat, until their 
uteri are filled to bursting with eggs, when they gradually de- 
scend the large intestine and deposit the chief part of their eggs 
in the rectum, and occasionally even leave the latter and creep 
about on the moist skin around the anus. All, eggs, males and 
females, are finally expelled mechanically with the feces. New 
crops of oxyurides can originate only if ripe eggs are being intro- 
duced again into the stomach where, by the action of the gastric 
juice and the heat of the stomach, they are hatched in a short 
time, and the young, very small, fine, delicate worms betake 
themselves at once to the upper portion of the small intestine, 
increasing rapidly in size to their full maturity. 

The ripe eggs may be brought to the mouth of infants even 
during birth and later, by the dirty hands o'f the mother or 
nurse, or in larger children and grown persons by their own 
hands, as a kind of self-infection; they may be imparted by 



570 INTESTINAL CANAL. 

bakers, fruit dealers, cooks, waiters, etc. This is the view taken 
by Leuckart, Zenker and others, resting on numerous experiments, 
while Vix conceives "that all the transformations from the em- 
bryo to the adult form take place within the intestine of the in- 
fested person without any necessary migration," a view which is 
not in accord with the general law of development in parasitic 
animals, nor does it explain all the known facts. 

Symptoms appear not until the oxyurides come down to the 
rectum, where they, by their active boring movements, cause an 
intolerable tickling and painful itching just within the sphincter 
and in the folds of the anus, which sometimes, especially at 
night, becomes almost unbearable. In the female it is peculiarly 
distressing, from the habit which the worm has of wandering 
into the vagina; it may produce inordinate sexual excitement in 
both sexes by sympathetic irritation, and cause erections, pru- 
ritus, even nymphomania with consequent masturbation. 

Cleanliness of the most scrupulous kind and injections of cold 
water are generally sufficient for the removal of these parasites, 
which have not a very long life. The nightly restlessness and 
intolerable itching which they produce as long as they exist, is 
most always relieved by Aconite. 

2. The Ascaris lumbricoides, round worm,is of a cylindrical form, 
tapering at both extremities. The female reaches, according to 
Leuckart, 15 inches in length by i inch to \ inch in breadth, 
and the male 10 inches by -| inch. It is of a light brownish or 
dirty reddish-yellow color. Its head consists of three semi-circu- 
lar lips, the bases of which are separated from the remainder of 
the body hy a well-marked circular furrow. The mouth consists 
of the triangular opening formed by the three lips. The tail of 
the male is always bent towards the abdomen like a hook, on 
which is seen the cloaca! aperture with two spiculse, which fre- 
quently project. The female sexual organs open in a vulva ex- 
ternally at the termination of the anterior third of the body. 
The ova have a conical form when unripe and are oval when 
ripe, and have a dark, tough, double shell, and very dark granu- 
lar contents; they measure ^^ inch by T ^ inch, and their num- 
ber has been calculated by Eschricht and Leuckart at about sixty 
millions in a single female, of which over 160,000 are daily dis- 
charged into the' intestine of its bearer. If now a person is the 
possessor of several of these worms, it can easily be seen that his 
evacuations must become so thoroughly charged with these eggs, 



INTESTINAL WORMS. 571 

that their discovery by the microscope cannot be of any difficulty. 
But their further development is not yet fully understood. It 
may be that the ova hatch in the stomach after being conveyed 
there directly ; it may be that an intermediate host be necessary 
for their development. However this may be, the development 
of the worm, once introduced, must be very rapid, for it is quite 
seldom that very young animals are found in the intestine. 

The round worm normally inhabits the small intestine, but has 
a marked tendency to wander and creep into small apertures, so 
that it is led sometimes through fistulous channels to quite re- 
mote cavities or organs; it has been found in the pleural sac, the 
gall bladder, the biliary ducts, the spleen, the kidney, the blad- 
der, the muscles of the loin or neck, the spinal cord, the lung, 
the glottis, the trachea and the Eustachian tube. In the Surgi- 
cal Museum, at Washington, I have seen the preparation of 
larynx, into which a round worm had entered and caused death 
by suffocation. 

Symptoms. — When this worm is present in moderate numbers, 
and occupies its normal habitation in otherwise healthy persons, 
there is often no disturbance discoverable ; but when present in 
greater numbers or infecting a delicate person it may give rise to 
abdominal griping, increased secretion of slime, diarrhoea, vomiting, 
irregular appetite; or, they cause reflex or sympathetic symptoms, 
as, itching of the nose, anus, genitals; enlargement of the pupils, squint- 
ing, increased flow of saliva, restless sleep, with frequent starting and 
grating of teeth. 

Symptoms like the following: cachectic countenance; blue 
rings around the eyes; enlarged abdomen, fever, irritation of the 
brain, fits, convulsions, etc., which have been ascribed to worms, 
are rather doubtful. In such cases a careful examination will, 
no doubt, lead to other exciting causes. 

THERAPEUTIC HINTS.— In the first place there is no need of 
disturbing the system with so-called vermifuges. Worms won't 
eat up a child, nor kill anybody, except in those very rare cases 
where "one of the critters goes into a wrong passage." 

Secondly, those symptoms of irritation are easily subdued if we 
choose homceopathically between Cina, Spigel., Sulphur, Bellad., 
and other remedies. 



572 INTESTINAL CANAL. 

Tape-Worms. 

"The tape-worm must be looked upon as a colony of animals 
Laving an alternation of generation. The so-called head is the 
larva-like nurse ; the segments of the worm — the proglottides — 
are the animals with sexual organs. From the head (scolex), 
without any mingling of the sexes, are produced the segments 
by a process of budding. The segments remain joined together 
for a considerable time, but, after they have come to maturity, 
they separate from the rest of the colony. The head is provided 
with either two or four suckers, and very frequently with a circlet 
of numerous small hooks. By means of this apparatus it fastens 
itself to the mucous membrane of the intestine of its host. As 
the segments of the chain, the sexual animals, increase the dis- 
tance from the head, by the development and insertion of fresh 
segments, they become sexually more developed, increasing at 
the same time in size. They are hermaphroditic, and generate 
eggs, in which a six-hooked embryo becomes developed. If eggs 
containing these embryos find entry into the stomach of a suit- 
able animal, their envelopes become softened or undone, and the 
embryos are set free. By some way or other they leave the diges- 
tive canal and make their way to different parts of the body. If 
they now meet with conditions favorable to their further growth, 
"nurses" are developed in them. Should these again happen to 
be introduced into the intestinal tract of another animal, they 
fasten themselves on, and another tape-worm colony becomes 
developed by budding. The time required for the development 
of the tape-worm colony, viz., till the sexual organs are fully de- 
veloped and segments are given off, is from eight to twelve weeks. 
The tape-worm inhabits the small intestine, where, folded into 
many coils, it lies surrounded with chyme ; it can move but little 
from its original position. Its muscular system seems, in the 
total absence of anything like an alimentary canal, to serve 
chiefly as a means of imbibing nourishment, the alternate con- 
traction and relaxation of the several groups of muscles having 
an effect similar to that produced by a force-pump." (Heller.) 
This is characteristic of all kinds of tape-worms, of which we 
have separately to consider : 

1. Taenia solium, or the Armed tape-worm, which attains a length 
of from 7 to 10 feet, seldom much more. Its head is about the 
size of a small pin's head, somewhat quadrilateral, owing to the 



TArE-WORMS. 573 

four prominent sucking discs. On its top front is a moderately 
prominent rostellum, on which is placed a coronet of small hooks 
arranged in two circles, an outer and an inner one. Its slender 
neck is nearly an inch in length, but exhibits to the naked eve 
no segmentation, it only gradually passes into distinctly visible 
segments, which at first are so much shorter than broad, that 
one-half of the whole are found in the anterior ninth part of the 
entire worm. From this point the segments gradually increase 
in length more than in breadth, so that finally mature segments, 
Proglottides or Cucurbitina measure about one-half inch in length 
and one-quarter inch in breadth. From this point also the sexual 
organs are distinctly visible, and in about another ninth lower 
down, the impregnated eggs enter the uterus. The taenia solium 
being hermaphroditic, both male and female sexual organs are 
present in the same joint, and open by a common aperture on 




N^W 



(After Kiichenmeister.) 
a. Tjbkia Solium, b. Natural size. 
C. T JEN I a Mbdiocanellata, or Saginata. 

the margin and a little behind the middle of each segment, alter- 
nating irregularly from one side to the other. The uterus forms 
a straight line passing down the centre of the segment, from 
which from seven to twelve branches are given off on each side. 
Running along the whole length of each side of the worm is a 
vessel, with transverse communicating branches, which contains 
a liquid. 

The eggs are roundish, and measure when free about yl^j- inch. 
The ripe egg encloses the embryo, a delicate mass of protoplasm, 
armed with three pairs of fine, glistening hooks. After the ripe 
segments with their eggs have separated and been discharged 
with the faeces — it has been calculated that one moderate sized 



574 INTESTINAL CANAL. 

tape-worm contains about five millions of ripe ova — the free joints 
move about for a time, especially in moist and warm situations, 
and disseminate their ova widely. No doubt the vast majority 
of them perishes, but those which happen to be taken with the 
food into the stomach of a pig, or much more rarely into that of 
a man, are hatched under the action of the stomachic juices, and 
the freed embryo (pro-scolex), by a diligent use of its armature 
perforates the tissues of its present location, and ultimately set- 
tles, most generally, in the cellular tissue of the muscles, or in 
rare cases in the liver or brain. Here it remains and gradually 
develops into the well-known cysticercus cellulosse of measly pork. 
This metamorphosis requires about two months and a half for 
its completion. In this condition the animal remains unchanged 
for a period not yet certainly known, but which has been esti- 
mated at from three to six years. • If during this time one or sev- 
eral of the cysticerci happen to be transplanted into the stomach 
of man, which only can take place by the eating of raw or im- 
perfectly cooked measly pork, it or they are developed into the 
taenia solium, which takes its abode in the small intestine, and 
may infest the bearer for many years. 

2. Taenia saginata (Goeze), or Taenia canellata (Kuchenmeister), 
the unarmed or fat tope-worm, is much larger, when fully developed, 
and much stronger, thicker, fatter and less transparent than the 
taenia solium. Its head measures about T a g inch and has neither 
rostellum nor coronet of hooks, but four powerful and prominent 
suckers. Its larval form, the cisticercus taenia? saginata?, infests 
the flesh and organs of the ox, a fact which at once points out the 
chief difference between its life history and that of the taenia 
solium. It abounds in Abyssinia and South Africa and is also 
common in Europe and in this country, and full}' as frequent as 
taenia solium. 

3. Bothriocephahis latus (Bremser), ///' broad tape-worm, is the 
largest of all the tape-worms and commonly reaches a length of 
17 to 20 feet, and sometimes GO feet or more. Its head is oblong, 
or club-shaped, measures T \ ; inch by ^ inch and has on each 
side a fissure-like groove in which its suction apparatus is placed. 
When fresh the worm has a dull bluish-gray color. Its joints are 
much broader than long, until towards the end of the chain they 
become square. The genital pores are situated in the centre of 
the segments, and all are on the same side. 

"The ovum after a prolonged sojourn in water develops a 



TArE-WORM. 575 

ciliated embryo, which escapes through the aperture in the shell 
by forcing open the lid and is furnished with three pairs of 
booklets. On analogical grounds it is very probable that it enters 
into the body of some aquatic animal, possibly a fish, but proba- 
bly a mollusc, and then assumes the larval form, which is at 
present unknown. The intermediate bearer is probably eaten by 
man and the larva assumes the adult form in his intestine. 
Bothiiocephalus latus usually occurs several together; it has a 
somewhat limited geographical distribution; never having been 
found beyond the limits of Europe, in some countries of which 
only is it indigenous. It is common in the western cantons of 
Switzerland, Northwestern Russia, Sweden, Poland, Holland, 
Belgium and Eastern Prussia; it is less often met with in other 
parts of Germany and has occasionally been imported into 
Britain. Low-lying damp regions near the borders of seas and 
lakes are those in which it is most often abundant. It is found 
in persons of all ages and sexes, even children at the breast are 
not free from it." (W. H. Ransom.) 

Symptoms. — Some individuals experience not the slightest 
inconvenience from tape-worm. Others complain of pain in the 
stomach and bowels, especially after certain articles of food, nau- 
sea, variable appetite, slight diarrhoea or constipation. As reflex 
phenomena are mentioned: itching of the nose, headache, dizzi- 
ness, getting dark before the eyes, noises in the ears, palpitation 
of the heart, even chorea and epilepsy. All, or at least many of 
these symptoms may as well arise from some h} T sterical or hypo- 
chondriacal affection of the patient. However, in the case of 
taenia solium, which in its embryonic state may infest the most 
different organs of the human body, it is clear that such and 
other serious disturbances may arise from its presence. 

THERAPEUTIC HINTS.— If no offense is given, why should we 
use the cudgel. The above-mentioned symptoms are often re- 
lieved by a well-selected remedy, which may even cause the par- 
asite to leave. But at times persons have made up their minds 
to get rid of the " critter," no matter what it costs. As the safest 
and most expeditious of all the numerous tape-worm remedies, 
many have recommended — 

Kousso, or the flowers of Brayera anthelmintica, 2 or 3 drachms 
put into a tumblerful of water well stirred, so that none of the 
flowers swim on the top. This done in the evening, let it stand 



576 INTESTINAL CANAL. 

over night. Administer a cup of coffee before taking it in the 
morning, to prevent nausea. Then one-half of it is taken, and 
the other half, half an hour later. If inclination to vomit should 
set in, it is best subdued by lemon juice. The Taenia saginata 
requires a larger dose. 

Often tape-worms have been removed by the seeds of the common 
pumpkin, mashed up to a mush, or by the use of the cocoanut. 
The male shield-fern (Aspidium filix mas), or the bark of the Pome- 
granate root (Punica granatum), are other remedies frequently 
and often successfully applied. 

The surest prevention consists in avoiding the use of raw or 
not well-cooked pork and beef. 

Tricocephalus Dispar, 

Or the whip-worm, is from one to two inches long, thin in front 
like a thread, while its posterior portion is thicker. Its chosen 
residence is the csecum. There are no symptoms known by 
which it could be diagnosticated during life. Its life-history, as 
far as known, is similar to that of the seat-worm. 



Anchylostomum Duodenale, Dochmius s. Strongylus 
Duodenalis. 

It is a small, cylindrical worm, with its anterior portion, in 
which the head is situated, curved backwards. Its mouth is pro- 
vided with a bell-shaped capsule and at its anterior margin witli 
four strong, claw-like hooks and two smaller ones at the opposite 
side. The males measure T 4 ^ inch, and the females y^ inch in 
length. The tail of the male terminates in a three lobed bursa, 
in which are placed two thin spicula. The female's extremity is 
pointed and their genital opening lies somewhat behind the cen- 
tre of the body. The eggs are oval, and measure -^ inch by 
T oVir inch. They probably under favorable circumstances hatch, 
and the embryo enjoys a free existence for a time in mud and 
muddy water. If taken into the stomach it grows and passes 
down to the duodenum or jejunum and attaches itself by its 
powerfully armed mouth to the villi of the mucous membrane, 
and sucks the blood of its host. It has been found only in Italy, 
in Egypt, in the countries bordering the Nile, on the Comoro 
Islands, in Madagascar, in Brazil and Cayenne. It produces 



TRICHINA SPIRALIS. 577 

dangerous haemorrhages in the bowels, followed by an anaemic 

condition, which is often fatal, and is the cause of the so-called 
Egyptian chlorosis, the true nature of which was pointed out by 
Griesinger. Griesinger recommends turpentine against them. 

Trichina Spiralis. 

Only within the last twenty years trichines have become an 
object of pathological researches, although they had already been 
discovered by Hilton in the year 1821 as numerous white specks 
visible to the naked eye, in the muscles of a human body, but 
considered by him as cisticerci. Later, under the microscope, 
they proved to be calcified trichinae capsules, and about 1835 Paget 
detected in them a minute round worm, which was accurately 
described and named by Owen : Trichina spiralis, on account of 
its form being like a hair and of a spiral shape. However, every 
thing concerning the life-history of these animals remained un- 
known until Zenker, of Dresden, in the year 1860, called public 
attention to the fact that this little parasite was the cause of a 
very painful and even fatal disease. Since then by the labor of 
numerous investigators the following has been brought to light: 
"The trichina spiralis is met with under two forms, the intes- 
tinal trichina and the muscle trichina. The former or mature 
trichina is an extremely fine, round, thread-like, slightly coiled 
worm, with a still finer head, which gradually decreases in thick- 
ness towards its point ; its hinder extremity is rounded off rather 
abruptly." (Heller.) The males are from one-half to one-third 
smaller than the females, and are furnished at the caudal ex- 
tremity with two pointless, lobular appendages and a genital 
opening. The females have their vulva at about the termina- 
tion of the anterior fourth part of their whole length ; their eggs 
after being fructified develop in the uterus to embryos which are 
born free and living. The birth of the embn T os begins on the 
seventh day after the introduction of muscle-trichinse into the 
stomach, and may continue, as it appears, for weeks. Soon after 
birth the embryos commence to migrate, piercing either, as some 
assume, through the intestinal wall and wandering from thence 
through the loose connective tissue towards the muscles ; or they 
enter, as others suppose, the blood-vessels — either directly or by 
way of the lymph current, in which they are carried to the differ- 
ent muscular parts of the body. As soon as they reach the mus- 

37 



578 



INTESTINAL CANAL. 



cles they force themselve into the primitive fasciculi, cause dis- 
integration of the same, increase in length and thickness, and 
finally roll up in coils of greater or less size and become encap- 
suled. After a time a deposition of lime-salts takes place in the 
capsules, by which they become opaque and visible to the naked 
eye as little white specks; previous to this calcification only ex- 
perienced observers can detect them. Under certain circum- 
stances the muscle-trichinae die and may decay, or they petrify, 
break into pieces, and their former nature can be recognized only 
by the peculiar position occupied by the fragments. But as a 
general thing the vitality of the muscle-trichinae is almost un- 
limited and ends even not with the death of their host, while the 
intestinal trichinae very rarely live longer than from five to eight 
weeks, when their propagation has been finished. 




Y'i'l^ :!;?'. 




Trichi.sve. (After Heller.) 

a. Muscle-trichina', magnified. 

h. Capsulated and calcified muscle-trichina, slightly magnified. 

c. Calcified and broken. 

d. Capsulated. magnified. 



If it happens that the muscle-trichinse, by eating the meat of 
its host, be introduced into the stomach of man or a proper ani- 
mal, they will be freed from their capsules, become sexually ma- 
ture within about two and a half days, copulate, and after five 



TRICHINOSIS. 579 

days more the females will bring forth living embryos, which 
soon commence to migrate as above described. Trichines are 
found especially in swine, but have been observed also in the cat, 
rat, mouse, marmot, polecat, fox, marten, badger, hedgehog and 
raccoon, and have successfully been bred in rabbits and guinea- 
pigs, but exceptionally successful only in sheep, calves and dogs. 

From this it can be seen that the infection of man is princi- 
pally carried on by the eating of raw or not thoroughly boiled 
pork. 

The disease caused by the propagation of trichines in man has 
been called 

Trichinosis, 

Which commences, as a rule, with disturbances of the digestive 
apparatus, sometimes a few hours, at other times not before sev- 
eral days after the infecting meal, with variable symptoms, such 
as: uneasiness, fulness, nausea, retching, vomiting, diarrhoea, or 
constipation. In most cases there is an unpleasant and pasty 
taste in the mouth, and in many a loathsome, putrid odor. The 
muscular symptoms are the most important and painful. A con- 
stant symptom from the outset is a flabby condition of the mus- 
cles and painful sensation on motion, a muscular lameness. 
After the invasion of the muscles the symptoms may be trifling, 
even absent in light, and extremely violent in moderate and 
severe cases. Commencing seldom later than on the tenth day, 
they consist of various degrees of swelling and hardness and ex- 
treme sensitiveness to pressure of the muscles in general, or a 
permanent contraction of the flexors of the extremities, or a diffi- 
culty of chewing and swallowing in a degree that only fluid 
nourishment can be taken, or a hoarseness when the muscles of 
the larynx, and a difficulty of breathing when the diaphragm 
and the respiratory muscles are invaded. The fever in light 
cases is insignificant, in severe forms resembles that of an ordi- 
nary case of typhoid fever, or presents in lighter cases almost an 
intermittent type. There is seldom a chill at the onset, oftener 
slight shivering. The pulse varies at the beginning between 80 
and 90, and rises later to 100 or 120 beats in a minute. The 
temperature may rise to 105° F. Perspiration is usually very 
profuse, and continues throughout the whole disease. The ner- 
vous symptoms consist especially of sleeplessness, neuralgic attacks 



5o(J INTESTINAL CANAL. 

in the bowels, hyperesthesia of the skin in the form of pruritus 
or formication, either extending over the whole body or limited 
to single portions of the lower extremities, and in some cases of 
loss of hearing. The circulatory symptoms consist of oedematous 
swelling of the eyelids and face, which is the most characteristic 
sign of trichinosis, setting in most frequently on the seventh day, 
and at times disappearing after from two to five days, and reap- 
pearing again in some cases after a few weeks. (Edema of the 
extremities is often quite marked and lasting. 

The incubation varies from a few hours to several weeks, and it 
appears that some persons can tolerate a considerable number of 
trichines without experiencing any special disturbance. The 
muscle-trichinee must have attained a certain maturity in order 
to be capable of sustaining themselves in the stomach and of de- 
veloping and reaching the muscles, their ultimate abode. If 
transplanted too young into the stomach, they will be either de- 
stroyed by digestion, or will have to make up their deficiency in 
the intestine and require therefore a longer time for the develop- 
ment of embryos. Also, if the capsulated trichinae are much 
calcified, it will take a longer time to set them free. Just such 
uncertainty exists as to the duration of the disease itself. In 
some very light cases the whole course of trichinosis passes over 
in two or three weeks without even confining the patient to bed; 
while in somewhat severer cases convalescence begins in the fifth 
or sixth week, and grave cases take some four months and even 
then the convalescents frequently do not regain their full strength 
for a long time. A fatal termination occurs most frequently in 
the fourth, fifth or sixtli week, and generally as a consequence of 
paralysis of the respiratory organs. The percentage of deaths 
has been as high as thirty in a hundred. 

The Diagnosis in single cases is very difficult in the beginning 
of the disease, easier when several persons become diseased at the 
same time. The onset resembles closely a gastro-intestinal ca- 
tarrh, from which it differs, however, by a constantly increasing 
perspiration. 

The oedema of the face and eyelids, appearing on the seventh 
day, is another important feature, in as much as other diseases in 
which this symptom occurs (morbus Brightii, diseases of the 
heart, lungs or pleura) can easily be excluded. The urine in 
trichinosis is always free from albumen. But the diagnosis be- 
comes indisputable on the discovery of single trichina- in the 



TRICHINOSIS. 581 

stools, or upon the observation of muscle-trichina? in excised por- 
tions of muscle, or^also in the proven fact that the patient lias 
partaken of trichinous pork. 

THERAPEUTIC HINTS.— The best prophylaxis is not to eat any 
pork, ham, sausages, etc., which is not well boiled or roasted. 
The old school has ordered laxatives, turpentine, kali picroni- 
tricum and benzine, but without any marked effect. 

Dr. Hering has recommended the TeUurite of Potassa in half 
grain doses. For in accordance with the provings of Hansen 
and Mohler, this substance caused at once such a strong, garlic- 
like odor of the breath, that the prover had to withdraw from 
society for several weeks. This odor is owing to a volatile or- 
ganic compound, or perhaps telluretted hydrogen, into which the 
tellurite of potassa is converted, and may by its pervading the 
whole system, be likely the means of destroying the intruders. 

There are a few cases on record which have been treated ho- 
mceopathically by Apis, Arsen., etc., but likewise without any strik- 
ing effect. Although I never have seen a case of trichinosis, xvt, 
considering the totality of the symptoms of trichinosis, I feel 
strongly inclined to recommend Ledum palustre, For in the first 
place this herb has been used successfully to keep insects away 
from clothing. Secondly, it has been given successfully for in- 
sect stings and wounds caused by needles, and what can the 
wandering trichines be better compared with than millions of 
finest needles piercing the muscles'? And lastly, Ledum has the 
following symptoms which correspond to trichinosis : Bloated face ; 
want of appetite; nausea; constipation; violent tension in the hypo- 
chondriac region during inspiration and retention of breath ; op- 
pressed painful breathing; pain and drawing in the outer parts of 
the chest, especially during inspiration, accompanied with single 
stitches. Painful stiffness of the muscles; sensation as if the muscles 
had not their proper length, with pain as if sprained in every position, 
hid especially when touching the parts and when walking. 

Swelling, with tension and stinging hardness of the whole leg. 
Swelling of the leg extending to beyond the calves, with tensive 
pains; swelling of the feet; inflammatory or cedematous swelling 
of the feet and legs. Pain in the soles of the feet when walking, as 
if ecclnjmosed. Pressure in the soles of the feet, more violent dur- 
ing a walk. Bruised pain in the heel when walking. The limbs 
of the whole body arc painful, as if bruised and contused. Chilliness. 



582 INTESTINAL CANAL. 

Languor and weariness when sitting, standing or walking; faint- 
ing. Pimples'and boils, pustules on the forehead and other parts. 
(Edematous swelling, also of the skin of the whole body. 

SPECIAL HINTS TO HELMINTHIASIS.— Aeon., pain in the bowels; 
the umbilical region is hard and the whole belly bloated ; urging 
to stool without discharge, or slime only; nausea; accumulation 
of water in the mouth; or restlessness at night on account of 
intolerable itching and tingling at the anus, throwing the child 
into fever (seat-worms). 

Arg. nitr., periodical pain in the region of the liver and around 
the navel, with sickness at the stomach, retching, vomiting of 
tough mucus; menses irregular, but always discharge of thick, 
black, coagulated blood; gray-yellowish color of the face. 

Bellad., drowsiness; starting in sleep, grating of teeth, involun- 
tary discharge of feces and urine, or dysuria; squinting. 

Calc. carb., headache, dark rings around the eyes; pale, bloated 
face; thirst; thick, bloated belly; aching about the navel; diar- 
rhoea; easy perspiration from motion; scrofulous diathesis. 

China, pain in the belly worse at night, after eating; fulness of 
the abdomen, pyrosis, presstire in the stomach and retching; 
tremulous weakness all over. 

Cicuta, frequent hiccough and crying; pain in the nape of the 
neck ; spasmodic drawing of the head backwards, and tremor of 
the hands. 

Cina, restless sleep w 7 ith rolling of the eyes, dark rings around 
the eyes; squinting; enlarged pupils; constant rubbing the nose ; 
bleeding of the nose ; face pale, cold or red and hot ; loathing of 
food, or great hunger ; nausea ; vomiting ; pain in the umbilical 
region ; belly hard and distended ; constipation ; dry, hacking- 
cough at night ; feverishness ; convulsive motions of head and 
limbs. 

Euphorbia, loss of appetite, or voraciousness at times ; furred 
tongue, feverishness ; fetid breath : bloated stomach : constipation 
or diarrhoea; emaciation, peevishness, wakefulness. 

Ferrum, pale, wretched complexion, easily flushing: itching at 
the anus from seat-worms at night ; involuntary micturition. 

Pilix mas, frequent pain in the bowels, a kind of gnawing and 
boring; constipation; loss of appetite : furred tongue ; paleface; 
blue rings around the eyes ; itching of the nose ; irritable and 
cross. 



TRICHINOSIS. 583 

Ignat, itching at the anus from scat-worms; convulsions, with 
loss of consciousness and temporary inability to speak afterwards. 

Kousso, indigestion; loathing; sleeplessness; weakness with 
fainting; profuse and cold perspiration; emaciation; dull pain 
in the bowels; bloatedness; constipation, tape-worm and other 
worms. 

Lycop., arthritic pain and stiffness; chronic eruptions; wretched, 
dirty, pale, earthy complexion; flatulence, bloating the stomach 
and abdomen ; sensation of something crawling and moving in 
the bowels and stomach up and down ; constipation. 

Mercur., continuous greediness for eating ; he becomes weaker 
and weaker withal ; bad smell from the mouth ; itching of the 
anus; inflammation of the vulva; seat and round-worms. 

Punica granatum, vertigo, wavering before the eyes, enlarged 
pupils; yellow complexion; grating of teeth; accumulation of 
water in the mouth ; changing appetite ; gulping of watery fluid ; 
vomiting; sensation of something moving in the stomach; bloated 
bowels ; colic ; palpitation of the heart ; spasms ; syncope. 

Sabad., vomiting of round-worms, or nausea and retching, with 
a sensation of a worm in the pharynx ; or, in case of tape-worm, 
burning, boring and whirling in the umbilical region ; accumu- 
lation of water in the mouth; chilliness and sensitiveness to cold; 
sensation as if the abdomen were sunken in. 

SpigeL, nausea every morning before breakfast, always better 
after breakfast; dilated pupils; squinting; pale face; smarting 
in the nose ; sensation of a worm rising in the throat, better 
after eating; or vomiting of all she takes, with sour rising like 
vinegar from the stomach ; pain in the bowels ; dry, hard cough 
at night; palpitation of the heart. 

Silic, colic in children from worms. 

Sulphur, after Aeon, or Mercur. ; creeping in the nose; creeping 
and biting in the rectum ; passage of lumbricoides, ascarides and 
tsenia ; nausea before meals and faintness before dinner ; restless- 
ness at night. 

Stannum, Hahnemann and others have mentioned it as palliat- 
ing the symptoms caused by tape and round-worm. 

Tereb., burning and tingling in anus and rectum, lessened by 
applying cold water ; hunger after a square meal ; foul breath ; 
choking sensation; dry, hacking cough; spasms and convulsions; 
wakeful at night; screaming as if frightened; staring look, 
clenching of fingers ; twitching of different parts of the body. 



584 PERITONEUM. 

Teucrium is said to be specific against the terrible itching in the 
anus from thread-worm. 

In addition the following remedies may be merely mentioned 
as vermifuges : Apocyn. andr., Asclep. syr. and tuber., Chelone, 
Dolich. pruriens, Gelsem., Gnaphal., Helon., Podoph. 

Peritonitis. 

Its pathological character is like that of pleuritis or pericar- 
ditis — injection of the capillary vessels followed by exudation. 
This exudation is either— - 

1st. Of a serous nature, and then generally profuse, distending 
the abdomen to a considerable extent. Owing to its serosity it 
is easily absorbed. Or the exudation is — 

2d. Of a fibrous nature, coagulable lymph, at least predominantly 
so. This is apt to cause adhesion, not only between the layers 
of the peritoneum at different places, (thus forming sacs wherein 
the remaining fluid is retained) but it may create, also, strings 
or bands of fibrin, which fasten one portion of the intestine to 
another, and which may give rise to strangulation of a portion 
of the intestines. Or the exudation is — 

3d. More or less mixed with blood-globules, called hemorrhagic, 
mostly found in diseases which predispose to bleeding in different 
organs, as for instance scurvy, typhus, delirium tremens, exan- 
thematic fevers, etc. Or the exudation consists 

4th. Of pus or ichor, when it is called purulent or ichorous. The 
latter takes place only under the most unfavorable conditions, a 
generally depraved state of the blood, as in puerperal fevers. 
pyaemia, or when urine passes into the cavity of the abdomen. 

It is thus clear that a peritonitis is not necessarily cured simply 
because the inflammation has passed away: its product, the 
exudation, may yet give considerable trouble before it is removed. 

Peritonitis does not always involve the whole peritoneum, is 
not always general or diffused, but much oftener only partial or 
circumscribed, attacking only single portions, for instance those 
which cover the liver, spleen, kidneys, uterus or some parts of 
the intestines, being more or less complicated with inflammations 
of these organs. 

Its Causes are various. Primarily, it is most frequently brought 
on by external injuries: a blow, a tall, a penetrating wound, or 
by surgical operations, or by exposure to cold and wet. 



PERITONITIS. 585 

Secondarily, it may be a mere continuation of an already exist- 
ing inflammatory process of the liver, spleen, womb, bladder, 
caecum, etc., or it may arise in consequence of ulcerative processes 
within the intestines and subsequent perforations; also childbed- 
fever and menstruation are frequent causes of peritonitis. 

Symptoms. — Owing to these diverse causes peritonitis, consid- 
ered as a general form of disease, exhibits a great variety of 
manifestations which will change in individual cases. Indeed 
this is so with all forms of diseases. I can point out only those 
symptoms which are most apt to occur in all forms. 

1st. Pain is never absent and always severe ; it is described as 
sharp and lancinating, and is increased by the slightest motion or 
touch. Therefore the patient lies quietly on his back, with his 
thighs flexed, breathing only with the thorax, instinctively 
avoiding all action of the diaphragm. The slightest pressure 
increases the pain ; even that of the bed-clothes seems at times 
unbearable — a distinctive sign between peritonitis and colic. 

2d. Vomiting; at first, of the usual contents of the stomach, 
then of slimy and bilious, and lastly of green masses, as though 
verdigris had been taken into the stomach. It becomes stercora- 
ceous only when peritonitis is associated with obstruction of the 
bowels. The vomiting never relieves, but increases the pain 
considerably. 

3d. Singultus sets in especially when the serous covering of the 
diaphragm becomes involved in the inflammatory process. 

4th. Constipation — owing to the paralyzed state of the intestines 
— is a frequent symptom; but in cases of peritonitis puerperalis, 
or in combination with catarrhal inflammation, or ulceration 
within the intestines, there is almost always diarrhoea. 

5th. Great distention of the abdomen in consequence of accumu- 
lation of gas and fluid. This causes the diaphragm to rise into 
the thoracic cavity and to compress the lungs, producing conges- 
tion, short breathing, 40 to 60 times in a minute, and a disturb- 
ance of the circulation which may bring on cyanosis of the face. 

6th. Constant desire to urinate; painful micturition or retention of 
urine; always where the serous covering of the bladder is involved. 

7th. Fever; more or less intense according to the extension of 
the inflammation. The temperature may rise to 104 or 105° F., 
and higher, and the pulse from 120 to 130 in a minute. Gradu- 
ally, however, as the disease progresses, the pulse becomes small 
and flickering; the extremities cool, and covered with cold 
sweats; the features collapse. 



586 PERITONEUM. 

8th. Physical signs are not very readily elicited, as the patient 
can bear neither touch nor motion; although, of course, we may 
expect a dull sound on percussion where there is effusion, and a 
tympanitic sound where there is meteorism. Auscultation gives 
no signs, except rumbling in the bowels, which may be heard a 
yard off. 

That it is a dangerous disease we may conclude, if we consider 
for one moment its nature, and again, that this danger varies ac- 
cording to the cause, complication and extension of the disease. 
Simple cases, produced by bruises, taking cold, without other 
complications, are the least dangerous. Those caused by wounds 
are more or less dangerous, according to the nature of the wound. 
And the danger of those which are the secondary result from 
other inflammatory processes depends upon the nature of these 
processes. 

It is a good sign when, in the progress of the disease, the pain 
gradually abates and the pulse rallies. It is a bad sign when the 
pain abates and the pulse gets weaker and quicker. It is a sign 
of imminent danger when the pain suddenly subsides and the 
pulse becomes flickering and the features collapse. 

Cases which have become chronic terminate frequently in ma- 
rasmus and a variety of consecutive sufferings. It is possible 
that in such cases the purulent exudation perforates either some 
part of the intestine, or discharges outside through the abdomi- 
nal wall. 

THERAPEUTIC HINTS.— Aeon., hot, dry skin; quick, hard, small 
pulse; high, inflammatory fever; mouth and tongue dry: great 
thirst; bitter taste; vomiting; no stool; urine scanty, red and 
hot; lower extremities cool; short, quick breathing; very rest- 
less; anxious expression in the face: burning, cutting, darting 
pain in the bowels, worse from slightest pressure, motion and 
lying on the right side; abdomen hot to the touch. After taking 
cold, drinking cold water when being heated. 

Apis, burning, stinging pain in the bowels, very sore to the 
touch; when exudation has taken place; urine scanty, dark; 
cedematous swelling of the feet; burning, stinging in the region 
of the ovaries ; metritis. 

Arnica, after contusion. 

Arsen., later, when there is a sudden sinking of strength, cold, 
clammy perspiration, anxious, internal restlessness, insatiable 



PERITONITIS. 587 

thirst with drinking but little at a time; constant vomiting; 
burning in the bowels; all worse in the middle of the night. 

Bellad., after Aeon., great congestion to the head ; strongly pul- 
sating carotid arteries; light and noise unbearable; colicky pains 
in the bowels; painful retching and vomiting, worse from motion 
and contact; great anxiety and dyspnoea. Especially when in 
complication with metritis or perityphlitis. 

Bryon., stitching pain or pressing, lancinating in the bowels, 
worse from slightest motion; when exudation has taken place; 
tongue white and dry; great thirst; bowels constipated ; the pa- 
tient lies perfectly still, don't want to move. Especially in com- 
plication with diapliragmitis. 

Calc. carb., when about the seventh day a red rash appears ; also 
when the pain is alleviated by cold water applications, so that 
the patient wants them renewed constantly. Abdominal tuber- 
culosis. 

Canthar., abdomen burning hot; tympanitic distention in its 
upper region ; lower portion yields a dull sound ; bloody, slimy 
stools; painful, extorting cries; tenesmus of the bladder; stran- 
gury; great anguish and restlessness; distressed face; sunken 
features; cold extremities. Especially when the serous covering 
of the bladder is the seat of inflammation. 

Carb. veg., excessive tympanitis with paralysis of the bowels. 

Laches., abdomen hot and sensitive to touch; painful stiffness 
from the loins down into the thighs; scanty, turbid urine with 
reddish sediment; strangury; constipation; necessity of lying on 
the back with drawn-up knees. Especially in complication with 
typhlitis. 

Lycop., in complication with diapliragmitis or hepatitis ; when 
lying on the left side, a feeling as if a hard body were rolling 
from the navel to that side; or when after three or four days the 
face assumes a yellowish color ; troublesome flatulence and con- 
stipation; sleeplessness and constant loathing. 

Mercur., at a later period, if the exuded fluid becomes purulent, 
with frequent starts; creeping chills ; perspiration without relief ; 
pale, wretched complexion ; foul smell from the mouth ; vomiting 
of slime and slimy stools, with straining ; cedematous swelling of 
the feet; great weakness and emaciation. Especially when in 
complication with typhlitis and the formation of abscesses. 

Nitrum, stitching and sticking pains; predominating coldness 
of the lower extremities ; kind of numb and stiff feeling in the 
affected parts, as if they were made of wood. 



588 PERITONEUM. 

Nux vom., belching, vomiting and constant pressure upon the 
rectum, as if urging to stool. 

Opium, distention of the abdomen ; anxiety, with a feeling of 
flying heat internally, and stupefaction of the head ; somnolence; 
antiperistaltic motion of the intestines; constant vomiting and 
belching ; retention of stool and urine ; complete inactivity of the 
lower bowels. 

Rhus tox., great restlessness; changing position, notwithstand- 
ing the pain it causes ; tongue red at the tip ; pressive, cutting 
pain in the abdomen ; typhoid symptoms; febrislenta: metritis. 

Sulphur, after Aeon, and Bryon., or when tbe disease takes a 
protracted course. 

Veratr., vomiting and diarrhoea; coolness of the skin; sunken 
features; pulse small and weak; thirst great; restlessness and 
anxiety. , 

Ascites, Dropsy of the Peritoneum. 

Its pathological character is like that of hydrothorax, a collec- 
tion of fluid within the peritoneal sac, which is of a yellow, or 
yellowish-green, or (if blood be mixed with it) of a reddish color, 
and contains a great deal of albumen, saline constituents, and 
flakes of coagulated lymph. The quantity of fluid sometimes 
exceeds forty pounds. The peritoneum is opaque, without lustre, 
and thickened, but without any signs of inflammation. Liver 
and spleen are pale, sometimes smaller than normal ; the kid- 
neys appear anaemic, and the diaphragm is pushed upwards into 
the thoracic cavity. 

Dropsy of the belly is never a primary disease, but always the 
consequence of some morbid action, such as diseases of the lungs, 
heart, larynx, blood-vessels, liver, spleen, kidneys, of intermittent 
fever and cancer-cachexia. 

It may result from mere local troubles, such as impediments of 
circulation within the peritoneum by obstructions of the vena 
porta?, cirrhosis, and tumors of the liver, tubercular and carcino- 
matous degeneration of the peritoneum. Frequently several of 
these causes are in operation, and sometimes it may be difficult 
to find out the true cause. If it develops without any oedema 
of other parts, we may conclude that it is caused either by an ob- 
struction of the portal circulation, or by a degeneration of the 
peritoneum. If by disturbance of the portal circulation, we gen- 



ASCITES, DROPSY OF THE PERITONEUM. 589 

ci-ally find signs of disturbed action of the liver, and the mine 
containing bilious coloring matter; if by degeneration of the 
peritoneum, there are signs of cancer-cachexia, or tumors in the 
abdomen, the urine usually retaining its natural color. 

Symptoms. — 1. Swelling of the abdomen.. This alters its form 
according to the position of the patient. When standing, the 
hypogastric region swells out the most; when lying, the most 
dependent portion of the abdomen bulges out. This distin- 
guishes ascites from any other swelling within the abdominal 
cavity. 

2. Fluctuation, which is easily discovered by palpation. 

3. Diminution of urinary secretion and alvine evacuations (the 
latter excepted, where there is an intestinal catarrh co-existing). 

4. Dull percussion sound, also variable according to the patient's 
position. 

5. Pressure towards the thoracic cavity, with dyspnoea and palpi- 
tation of the heart, 

6. Enlargement of the veins in the lower extremities, and drop- 
sical swelling of the external genital organs and lower extremi- 
ties, in consequence of the pressure which the accumulation of 
fluid within the abdominal cavity exercises upon the vena cava 
and venae illiacae, causing obstruction of circulation in these 
parts. 

The Prognosis depends entirely upon the nature of its cause. 
If that is not removable, it is hardly to be expected that its con- 
sequences will be. The patient does not die in consequence of 
dropsy, but in consequence of the primary disease, if that be 
fatal, although dropsy by impeding the respiration, or by excori- 
ations or superficial gangrene may hasten this result. 

Ascites differs from dropsy of the ovaries by its causes, which 
close examination must elicit ; by its form, being a uniform dis- 
tention of the lower abdomen, rising gradually upwards. In 
dropsy of the ovaries, the swelling is more on the one or the 
other side, extending gradually sideways over the whole abdo- 
men ; by its changing form b) r change of position, which never 
occurs in dropsy of the ovaries, where the fluid is encysted. 

In our Therapeutic management of each individual case, 
therefore, we shall have to select remedies from those which are 
indicated for dropsical affections in general ; as Apis, Arsen., 
Bryon., China, Dulcam., Ledum, Lycop., Phosphor., Pulsat,, 
Rhus tox., Sepia, Strontian. 



590 PERITONEUM. 

Vomiting and diarrhoea suggests Ant. crud., Tart, emet, Apis, 
Argent., Arsen., Asar., Borax, Charnom., Cuprum, Ipec, Mercur., 
Phosphor., Senega, Sulphur, Yeratr. 

Ulcers on the legs, Arsen., Graphit, Helleb., Lycop., Mercur., 
Rhus tox., Scilla, Sulphur. 

(Edema of the lower limbs, with constant oozing out of the water 
from sore places without formation of pus, Rhus tox., afterwards 
Lycop. 

Cough, with dropsy, Amm. carb., Apis, Arsen., Colchio, Helleb., 
Nitr. ac. 

SPECIAL HINTS. — Apis, urine scanty, dark, like coffee-grounds ; 
thirstlessness ; great soreness of the abdominal walls; stinging, 
burning pains in different parts of the body ; can't get breath, 
except when sitting ; even leaning backwards causes suffocating 
feeling ; in complication with scarlet fever, uterine tumors, and 
inflammatory processes of the bowels. 

Apoc. cairn., has been given abundantly by western physicians 
for "dropsy" of all kinds; seems to be indicated by a sinking 
feeling at the pit of the stomach ; an irritable condition of the 
stomach, that cannot retain even a draught of water; muddy 
urine ; diarrhoea ; bloatedness of the face after lying down, pass- 
ing off after sitting up ; dropsy after scarlatina. 

Arsen., complexion pale and earthy, or greenish; great weak- 
ness, exhaustion ; faint feeling from slight motion ; tongue dry ; 
great thirst, with frequent drinking, but only little at a time ; 
suffocative spells, especially at night; great anxiety; must jump 
out of bed ; skin cool ; burning heat inside ; post-scarlatinal 
dropsy ; in complication with heart diseases. 

Aurum, has been recommended when ascites is the consequence 
of functional disturbance of abdominal organs, in combination 
with albuminuria. 

Bryon., congestion of the head ; giddiness when rising after 
stooping ; loss of breath when moving in the least : lower eye- 
lids cedematously swollen ; lips bluish ; great thirst and scanty 
urine, with burning in the urethra, passing off drop by drop: 
obstinate constipation ; after scarlet fever. 

Canthar., cured many cases according to Faivre. 

China, indicated in organic disturbances of liver and spleen, 
and after loss of blood. 

Colonic, palpitation of heart, and dyspnoea from 11 to 3 o'clock 



ASCITES, DROPSY OF THE PERITONEUM. 591 

in the night, burning in pit of stomach, afterwards nausea, finally 
vomiting with subsequent weakness and sometimes ravenous 
hunger. Skin dry and pale. (F. Pollock.) Urine scanty, look- 
ing like bits of decompsed blood, with offensive smell. (W. 
McGeorge.) 

Convulvulus arv., constipation ; abdominal disturbances, weak- 
ness, appetite good; he would eat more if there were more room, 
the abdomen being filled with water ; urine almost entirely sup- 
pressed. 

Digit, difficult micturition ; pale face; intermitting pulse; cold 
skin ; doughy swelling, which easily yields to the pressure of the 
finger. 

Fluor, ac, enlarged and indurated liver, in consequence of 
drinking whiskey. 

Graphit., great oedema of lower extremities with profuse watery 
exudation below knees ; exudation gelatinous. (H. V. Miller.) 

Helleb., in acute cases; after scarlet fever; drowsiness; slow 
in answering questions; griping in bowels, with jelly-like dis- 
charges; frequent but scanty micturition; great thirst; fever; 
sympathetic neuralgia of face into teeth on left side ; preventing 
chewing. 

Kali carb., in complication with liver and heart affections. 

Laches., in complication with liver, heart and spleen diseases, 
scarlet fever ; black, scanty urine. 

Lycop., liver affections ; abuse of alcoholic drinks ; after vene- 
section, or intermittent fever; oozing out of water from sore 
places in the lower extremities, without formation of pus; urine 
scanty, with red sediment; upper portion of the body emaciated, 
lower enormously swollen; one foot cold, the other hot; restless 
sleep ; cross when getting awake. 

Mangan. ox., intermittent fever; cachexia; palpitation of the 
heart, strong, irregular, tumbling, without abnormal sounds. 

Mercur., in consequence of organic lesions of the liver and other 
abdominal viscera ; the swelling of the abdomen is tense, hard ; 
thirst not prominent. 

Senec, abdomen very tense ; lower extremities cedematous ; 
urine scanty and high-colored, or alternating with profuse and 
watery discharge; pain in the lumbar region and in the ovaries. 

Sulphur, after suppressed itch, rough skin; bluish spots; sleep, 
with moaning; quick pulse; cold feet; easily sweating, especially 
in the face; painless diarrhoea; drawing together of the fingers; 
very forgetful ; inclination to sit still and to lie down. 



592 LIVER. 

Paracentesis with the usual trocar causes adynamia, rapid 
return of the fluid and often peritonitis. 

Capillary punction allows a slow withdrawal of the fluid, causes 
less ad}mamia and less frequently peritonitis. (Leudet.) 

Tympanites Abdominalis 

Corresponds to Pneumothorax, and consists of a collection of gas 
within the peritoneal sac. It is caused by ruptures or perforations 
of the stomach or of the intestines, in consequence of which the 
gas which is contained therein diffuses itself within the peritoneal 
sac. More rarely the air finds its way into the abdominal cavity 
from out of the lungs (in consequence of abscesses and pneumo- 
thorax) ; and still more rarely it enters from the uterus or the 
vagina in consequence of destructive processes in these organs. 
Cases have been observed where the gas originates within the 
peritoneal sac itself, in consequence of a decomposition of ichor- 
ous fluids contained therein, especially in combination with 
puerperal peritonitis. 

Symptoms. — Swelling of the abdomen. Its development is rapid 
if it be caused by perforation ; slower, if by gradual decom- 
position. 

Full tympanitic sound all over, even in the region of the liver. 
This organ is pressed backwards, if it be not adherent to the 
diaphragm ; this is quite characteristic and serves to distinguish 
tympanitis from meteorism, i. e. a collection of gas within the 
intestines. 

All signs of peritonitis, which develops itself soon after the 
entrance of air into the peritoneal sac. 

THERAPEUTIC HINTS.— Compare Peritonitis and those other 
affections of which it is a mere consequence. 

DISEASES OF THE LIVER. 

Physical examination. — The upper part of the liver extends into 
the space between the fifth and fourth, sometimes even to the 
edge of the fourth rib. Being, however, overlapped here by the 
lower edge of the right lung, which reaches down to the sixth 
rib, we find on percussion the perfect, dull liver-sound commenc- 
ing only from the sixth rib, while above it to the fourth rib the 



PIGMENT AND MELAN.EMIC LIVER. 593 

dull sound can be elicited only by bard strokes, sounding through 
the layer of the lung tissue that covers the liver. Interiorly the 
liver reaches to the tenth rib in the right hypoehondrium, whence 
it ascends in a somewhat semi-lunar line across the epigastrium, 
midway (or often a little higher than midway) between the ensi- 
form cartilage and the navel, towards the left hypoehondrium. 
Percussion in a horizontal line from the ensiform cartilage 
towards the left, a little under the region where the apex of the 
heart strikes, tells us bow far into the left hypoehondrium the 
left lobe of the liver reaches. 

This normal position, however, may be changed without indi- 
cating any disease of the liver itself. The liver is dislocated 
doumwards by emphysema, pleuritic effusions, pneumo-, pyo- or 
hydrothorax of the right lung; it is dislocated upivards by fluid 
or gaseous collections, or tumors within the abdominal cavity, or 
in consequence of a shrinking of the right lung. Its surface be- 
comes grooved by tight lacing of corsets and waists of petticoats in 
females, and of pantaloons in males. Part of the right lobe may, 
by this long-continued process, be brought down to the anterior 
superior spinous process. 

Pigment Liver, Melanaemic Liver resulting from Mala- 
rial Fevers. 

The liver presents a steel-gray or blackish, or chocolate color, 
in consequence of an accumulation of pigment matter in its vas- 
cular apparatus. These deposits are either uniformly distributed, 
or limited only to certain portions. Similar appearances are 
constantly found also in the spleen, frequently in the capillaries 
of the lungs, also in the brain, especially in its cortical substance, 
and in the kidneys. Even the other organs and tissues, such as 
the external integument, the mucous membranes, the muscular 
tissue, etc., remain by no means exempt, as may be seen by their 
gray tint. The pigment seems to be carried everywhere by the 
blood, and the effects upon the system of this morbid process in 
consequence of malarial fevers will, of course, vary according to 
the organs which are most specially attacked. We will find 
cases with predominant brain symptoms, others with predominant 
symptoms of the kidneys, others with predominant derangements 
of the gastro-intestincd tract and the liver, and others where anscmia 



594 LITER. 

and hydreemia, resulting from affections of the spleen, constitute 
the most important morbid conditions. 

Hyperemia, Congestion of the Liver. 

One of the most frequent causes is obstruction to the circula- 
tion of blood in consequence of valvular diseases of the heart, 
such as constriction of the left auriculo-ventricular opening, in- 
sufficiency of the mitral and still more of the tricuspid valves, 
and further, affections of the lungs, such as emphysema, exten- 
sive induration or atelectasis, great pleuritic effusions, etc., which 
all give rise to accumulations of blood in the vena? cavse, by 
which the branches of the hepatic vein continue permanently 
distended, and cause a general enlargement of the liver. On sec- 
tion, the organ presents a nutmeg-like appearance. The dark 
spots correspond to the situations of the hepatic veins, and the 
light-colored portions of the parenchyma, exhibiting upon closer 
inspection pale, delicate ramifications, correspond to branches of 
the portal vein, and constitute the so-called Nutmeg liver. From 
the persistence of this obstruction the hepatic parenchyma grad- 
ually atrophies and at last acquires a finely-granular structure, 
which frequently has been confounded with cirrhosis of the liver. 
This is the atrophic form of nutmeg liver. Besides the symptoms 
of the cardiac or pulmonary disease, which constitutes the pri- 
mary cause of the circulatory obstruction, we observe derange- 
ments of digestion, pains and tension in the epigastrium, nausea, 
etc., and occasionally haemorrhoids. Sooner or later it leads to 
death from pulmonary oedema, apoplexy, general dropsy, etc. 

Congestion of the liver may be induced also by rich living, 
especially in persons of a sedentary habit. Stimulants and irri- 
tants, such as alcoholic drinks, pepper, mustard, coffee, etc., in 
large quantities frequently give rise to this trouble, and quite 
marked is the influence of hot climates and of miasmatic effluvia. 
The hepatic hyperemias of the tropics are often associated with 
dysentery or malarious fevers. In the latter case there is also 
swelling of the spleen or kidneys. 

Its acute form is characterized by more or less painful distention 
of the region of the liver, with dyspnoea and pain stretching to- 
wards the right shoulder, by headache, nausea and vomiting of 
mucus or green matter ; by constipation or diarrhoea, which is 
bilious or even bloody. This state of things, by proper treatment, 



PIGMENT AND MELAN.EMIC LIVER. 595 

may entirely subside; if neglected it may give rise to a chronic 

form which shows more or less periodical exacerbations of these 
symptoms, and finally runs into structural changes of the liver, 
such as softening, or pale and jaundiced or fatty degeneration, 
or induration, cirrhosis and abscesses. 

In temperate climates this affection is much less violent than 
in the tropics, but may also assume a chronic form and produce 
enlargement of the liver by fatty deposits, or infiltration of its 
parenchyma with albuminous substance, which gradually passes 
into colloid degeneration, and in rare cases becomes cirrhosed. 

A hyperemia of the liver in consequence of the suppression of 
habitual haemorrhages, for instance during the climacteric period 
of life, has frequently been observed ; it usually does not give 
rise to any serious derangement in the nutrition of the liver. 

THERAPEUTIC HINTS.— In acute cases: 

Bellad., high fever; congestion of the head; severe headache; 
vomiting of a watery, slimy and bilious fluid ; great thirst : re- 
gion of the liver painful and sore to the touch. 

Bryon., bilious vomiting ; bitter taste ; white tongue ; great 
thirst or only dryness in the mouth ; inclination to keep still ; 
soreness of the liver to pressure ; costiveness. 

Card, mar., when constipation frequently alternates with diar- 
rhoea. 

Chamom., after anger or chagrin ; very annoying pressure in 
the region of the liver ; colicky pains in the bowels ; vomiting of 
bile; feverish restlessness : crossness; icteric color of the face. 

China, pale, wretched complexion; diarrhoea, worse at night or 
after eating; sensitiveness to external cold; great weakness and 
lassitude ; after severe illness, loss of vital fluids, or abuse of 
mercury. 

Ignat, after grief or fright, especially in the female sex ; men- 
struation profuse and irregular; leucorrhcea, with bearing-down 
pain. 

Mercur.. bad taste ; bad smell from the mouth ; tongue white, 
flabby, showing the imprints of the teeth ; feverishness ; sweating 
without relief. 

Nux vom., fulness; pressure; stitches in the liver, worse from 
motion or contact : swelling of the liver ; yellow color of the face, 
especially if the color of the face is florid with a yellowish tinge ; 
all worse in the morning ; great irritability and hypochondriac 
mood ; costiveness. 



596 LIVEK. 

In cl ironic cases: Calc. carb., Carb. veg., Grapbit., Lycop., Magn. mur., 
Natr. mur., Natr. sulpb., Sepia, Sulphur. 

Compare also the diseases of the heart and lungs, of which con- 
gestion of the liver is more or less a consecutive symptom ; also 
the chapters on acute and chronic catarrh of the stomach and in- 
testines. Besides all this, the following require special study — 

Lacbes., cannot bear tight clothes around the waist; has even to 
loosen the night-jacket to relieve the oppression, which is occa- 
sioned even by laying the arm on the body; tension; contractive 
tightness in the region of the liver. 

Lauroc, distention of the region of the liver, with pain as from 
subcutaneous ulceration, or as if an abscess would burst; earthy 
complexion ; yellowish spots in the face. 

Lycop., tension around the hypochondria as from a hoop; sore 
aching in the region of the liver, -as if caused by a shock, worse 
from contact. 

Nux moscb., feeling of heaviness in the region of the liver; 
swollen liver; bloody stools. 

Podopb., fulness, with pain or soreness in the right hypochon- 
drium; chronic hepatitis, with costiveness; the patient is con- 
stantly rubbing and stroking the region of the liver with his 
hands. 

Peri-Hepatitis, Inflammation of the Capsule of the Liver 
and of Glisson's Capsule. 

It may be part of a general peritonitis, or the consequence of 
an abscess of the liver, of simple, or cirrhotic induration, of cancer, 
or of echinococci in the liver; it is at times the result of external 
violence, or a mere extension of an inflammatory process of some 
neighboring organs, such as right pleurisy, and simple and can- 
cerous inflammation of the stomach. 

Its most characteristic symptom is, tenderness of the hepatic 
region on pressure, motion and deep inspiration, without any 
change in the volume or situation of the liver. In itself it is not 
a dangerous disease, but may produce thickening of Glisson's 
capsules and of the portal vein. Its treatment compare under 
peritonitis and the diseases of which it may be the consequence. 



HEPATITIS VERA CIRCUMSCRIPTA SEU SUPPURATIVA. 597 

Hepatitis vera circumscripta seu Suppurativa. 

This is an inflammation of the hepatic tissue limited to one or 
several isolated patches, without implicating the remaining por- 
tions of the gland to any great extent, In their centre, these in- 
flamed spots are soft and yellowish, at their periphery they show 
hyperaemia, swelling and softening of the liver tissue. In the 
progress of the disease little pus globules form in the middle of 
the inflamed spot, they increase in number, unite and form a 
small abscess, which again unites with other small abscesses, and 
thus, in the course of time, the greater part of the liver may be- 
come an irregular cavity filled with pus. 

Such abscesses are found in the posterior portion of the right 
lobe. When they reach the surface of the liver, they break 
through and discharge their contents into the abdominal cavity ; 
or, if the surface of the liver has formed adhesions, in conse- 
quence of previous inflammation, with neighboring organs — 
either with the abdominal walls, the diaphragm, the stomach, 
the gall-bladder, or a part of the intestines — it perforates these 
organs, and discharges itself either through the abdominal walls, 
or into the thoracic cavity, stomach, gall-bladder, or intestines, 
according to its situation and adhesion. 

Hepatitis is primarily a very rare disease, and is mostly 
brought on by external injuries — a fall, a blow, a wound, etc. 

Secondarily it is caused by the irritation of hardened concre- 
ments within the gall-ducts, or by ulcerative processes within 
the stomach and the intestines, which perforate and spread upon 
the surface of the liver. In tropical climates it has most fre- 
quently been found in connection with dysentery. Pyaemia, in 
consequence of wounds on the head or on any other part of the 
body, is also a cause of it. 

Symptoms. — A primary hepatitis caused by a blow, fall, or 
other mechanical injury occasions pain in the right hypochon- 
drium ; frequently very acute, as its lining portion of the perito- 
neum is likewise inflamed: it is worse from any motion. There 
is also pain in the right shoulder, and on tension, in the right 
straight abdominal muscles. The liver is swollen; the skin more 
or less yellowish discolored (icterus); fevers alternate with rigors. 

A secondary hepatitis, in the course of ulcerative processes in 
the stomach and intestines, manifests itself by shaking chills, 
pain in the liver, swelling of the liver and icterus, though the 
latter is not always present. 



598 LIVER. 

Hepatitis in consequence of pyaemia manifests itself likewise in 
swelling of the liver, icterus and shaking chills. Formation of 
abscesses on the convex portion of the liver often bulge out, and 
may be detected by palpation. Those on its concave side com- 
press the portal vein, and cause swelling of the spleen and ascites. 

Small abscesses may pass over without any marked symptoms. 
Large abscesses cause fever, shaking chills, wasting away, ca- 
chectic appearance. 

Perforation through the abdominal walls, after previous adhe- 
sion of the inflamed portion of the liver with the abdominal 
parietes, is the most favorable, as, in this case, the pus is dis- 
charged outside. 

Perforation into the pleural sac causes pleuritis; a perforation 
into one of the larger bronchi causes the pus to be expectorated ; 
a perforation into the pericardial sac causes pericarditis, which 
is fatal. If the perforation takes place into the stomach, it is 
thrown up; and if into the intestines, it is discharged through 
the bowels. A discharge into the abdominal cavity produces 
fatal peritonitis. 

All this shows that hepatitis and its consequences must cause 
quite a variety of symptoms; that its prognosis generally is un- 
favorable; and lastly, that a successful treatment, without a close 
study of the individual case, is quite impossible. Still, I may 
mention the following remedies, which have proved themselves 
more or less beneficial in abscesses of the liver: Bellad., Brvon., 
Laches., Xux vom., Pulsat., Puta, Sepia, Silic, Kali carb., Merc, 
sol., Hepar, China. 

SPECIAL HLVTS.— Compare what has been said under the head 
of Peritonitis. 

Arnica, in traumatic cases. 

Arsen., painful bloatedness in the right hypoehondrium. with 
violent burning pain; violent thirst : vomiting of black masses; 
black stools; burning heat of the skin; anxiety and restlessness; 
very quick pulse; perforation into the stomach or intestines. 

Bellad., especially with acute pain in the region of the liver, 
worse from pressure, breathing, coughing and lying upon the 
right side, extending upwards towards the shoulder and neck; 
congestion of the head; getting dark before the eyes: fainting 
and giddiness ; bloatedness of the pit of the stomach : tension 
across the epigastrium; agonizing tossing about; sleeplessness or 
w r anting to sleep, with inability to go to sleep. 



HEPATITIS VERA CIRCUMSCRIPTA SEU SUPPURATIVA. 599 

Bryon., burning and stitching pain, worse from motion and 
contact; after chagrin or anger; fulness of stomach and abdo- 
men; pain in the right shoulder; yellowish face; white tongue ; 
great thirst; constipation. 

Chelid., crampy pain in the inner angle of the right shoulder- 
blade ; shooting pain from the liver into the back; pressive pain 
in the back part of the head, towards the left ear; pressure in the 
eyeballs; bitter taste in the mouth; nausea; palpitation of the 
heart, with very quick and irregular pulsation and without 
abnormal sounds; constipation. 

China, pain as from subcutaneous ulceration, worse from touch; 
liver swollen; diarrhoea; distended veins on the face and head. 

Hepar, when suppuration takes place. 

Kali carb., pain through to the back; abscess; dryness of the 
skin. 

Laches., after Bellad. or Mercur., very sensitive to any pressure 
upon the hypochondriac region; much flatulence; palpitation of 
the heart; formation of abscesses. 

Leptand., yellow-coated tongue ; constant nausea and vomiting ; 
aching in the region of the liver; dark-brownish urine; black 
stools. 

Lycop., in slow cases; complication with pneumonia; fan-like 
motion of the nostrils when breathing; one foot hot, the other 
cold. 

Mercur., pressive pain and stitches in the liver; inability to lie 
on the right side; when coughing or sneezing a stitch-pain 
through middle of the chest from front to back; yellowish tinge 
of the face; perspiration without improvement; during fever 
feels chilly when changing the feet to a cooler place in the bed. 

Nirx vom., pain, stitch- like, or throbbing, or pressive, worse from 
external pressure; sour or bitter taste in the mouth; nausea; 
vomiting; shortness of breath; the dress seems oppressive; the 
removal of it, however, does not relieve; great deal of headache. 
Previous use of allopathic medicines, coffee, liquor, etc. ; sedentary 
habits. 

Phosph. ac, pyaamic symptoms. 

Pulsat, spells of great anxiety at night; green, slimy diarrhoea; 
thirstlessness. 

Silic, hardness and distention of the region of the liver ; throb- 
bing, ulcerative pain, increased by contact and motion; forma- 
tion of ; 



600 LIVER. 

Sulplmr, especially after Nux vom. and Mercur.; red tip of 
tongue; red lips; sleeplessness. 

Cirrhosis, Hob-nail Liver, Interstitial Inflammation of the 
Liver, Granulated Liver, Gin-drinkers' Liver. 

It is a chronic inflammation of the areolar tissue, which, being 
of a fibrous texture, forms a capsule over the entire liver, enters 
as Glisson's capsule into the interior of the gland and accom- 
panies the vessels, nerves and bile-ducts to their finest ramifica- 
tions. The next consequence of inflammatory action of this tis- 
sue is exudation of coagulable lymph, which forms new areolar 
tissue and adhesions between its ramifications, causing the se- 
creting cells of the liver to become isolated and compressed, and 
producing in this way larger or smaller granulations, which 
have been compared to hob-nails. In the further progress, the 
new formation compresses also the biliary ducts and blood-ves- 
sels, and the whole organ shrinks, becomes hard, tough, pale, 
ansemic, and, if cut, appears gray -yellowish, wherefore the name 
cirrhosis. Its most frequent Cause is the abuse of alcoholic drinks ; 
still it has been observed in individuals who were not addicted 
to drinking, and where it seemed to be in connection with syphi- 
lis, intermittent fever, suppressed menstruation, poor living. 

Heart diseases, according to Bamberger and others, do not 
cause it. It is much more frequently found in males than fe- 
males, rarely in children, and most frequently in persons over 
thirty years. 

Symptoms. — 1. The liver is, during the stage of exudation, con- 
siderably enlarged, and, during the stage of granulation, loses 
quite considerably in bulk, so that the left lobe disappears en- 
tirely. If we have an opportunity to observe its progress long- 
enough, we can witness this increase and gradual decrease of the 
liver, and in this way gain one of the most important aids in our 
diagnosis. 

2. Enlargement of the spleen is met in many, not all cases, in 
consequence of the obstructed circulation of blood within the 
portal vein and its branches, which impairs the free reflux of 
blood through the vena lienalis. This is an early symptom. 

3. Ascites appears later, but is a more constant accompaniment 
of granular induration, and depends upon the same obstruction 
of the portal circulation; still later oedema of the lower extremi- 
ties occurs. 



CIRRHOSIS, HOB-NAIL LIVER. 601 

4. Meteorismus, if strongly developed, causes difficulty in 
breathing. 

5. Dilatation of the abdominal vein*, caput medusae, appears not 

until an advanced stage of the disea.se. It is caused by the ob- 
structed portal circulation. The blood in its way from below, 
being stopped, forces its way through neighboring veins, widen- 
ing and dilating them, and thus forms a collateral circuit around 
the liver, until it reaches the vena cava. These widened and 
dilated veins appear sometimes like a large net-work over the 
walls of the whole abdomen, and even above it. 

6. Functional disturbances of the intestinal canal are of a varied 
nature. The appetite is, in some cases, not altered till very late; 
in others, again, want of appetite, nausea, belching of wind and 
vomiting predominate. The bowels are either constipated or di- 
arrhceic. In severe cases we find vomiting of blood and bloody 
stools. 

7. Loss of flesh and strcngtli sets in quite early, as a necessary con- 
sequence of imperfect circulation. 

8. Jaundice is, according to Bamberger, a prominent symptom 
of cirrhosis, other authors have not found it so frequent. It de- 
pends upon catarrh of the bile ducts, or upon compression of the 
hepatic duct, or upon constriction of the minute biliary ducts by 
the newly-for-med connective tissue. 

If we consider these symptoms, together with the preceding- 
abuse of spirituous liquors, we shall be enabled, in mosx cases, to 
make out a sure diagnosis. But for the sake of Differential 
Diagnosis I shall compare a few forms of disease which might 
be confounded with it. 

Stricture of the biliary duct is usually caused by gall-stones, and 
has its peculiar colicky spells, but no swelling of the spleen. 

Nutmeg liver is always the consequence of heart and lung dis- 
eases, and has no enlargement of the spleen. 

Cancer and tuberculosis of the peritoneum, with highly-developed 
ascites, may be sometimes difficult to discern; still we have here 
a quicker wasting away; perhaps also signs of cancer or tuber- 
cles in other organs, and a development of oedema of the lower 
limbs prior to the development of ascites; whilst in cirrhosis we 
have first ascites and afterwards cedematous swelling of the lower 
extremities. 

Cancer of the liver distinguishes itself by the peculiarly potato- 
shaped surface of the enlarged liver and the normal size of the 
spleen. 



602 LIVER. 

Hydatids of the liver give, on palpation, the sense of fluctuation; 
they do not impair the general nutrition, nor do they cause an 
enlargement of the spleen. 

Inflammation of the portal vein, with coagula forming in if, is a 
much more rapid process, and is not caused by previous abuse of 
spirituous liquors. 

Inflammation of the areolar tissue surrounding the biliary duets is 
characterized by the highest degree of icterus and the complete 
discoloration of the stools. 

Colloid or fatty infiltration of the liver never decreases in size, 
causes no icterus, and is found in scrofulous, rhachitic. or syphi- 
litic individuals, or as consequence of mercurial poisoning. 

Prognosis is favorable as long as the disease is still in its first 
stage. After granulation has formed throughout the organ, I do 
not believe that its parenchyma can be reorganized. 

THERAPEUTIC HINTS.— If the disease is brought on mainly by 
the abuse of spirituous liquors, especially whiskey and brandy, 
the first prescription, of course, must be, ''stop drinking." And, 
in order to destroy the appetite for alcoholic stimulants, our sec- 
ond prescription should be, "drink milk," and nothing but milk; 
live on milk-diet. After this we shall have a choice between 
these remedies, which are antidotes to alcohol : Xux vom., Bryon., 
Pulsat., Carb. veg., Sulphur, Arsen., etc. 

In its second stage we must be guided entirely by the charac- 
teristic symptoms of the individual case, and may choose from 
the following: Arg. nitr., Aurum, Card, mar., Chelid., Cinchona, 
Conium, Iodium, Laches., Leptand., Lycop., Magn. mur., Mercur., 
Natr. mur., Nitr. ac, Phosphor., Plumbum, Podoph., Quassia, 
Selen., Sepia, Tax. bacc. 

Syphilitic Inflammation of the Liver 

manifests itself 'either as an interstitial Itcpatitis tmd peri-hepatitis, 
which leave white depressions, like cicatrices, consisting of fibrous 
tissue and extending from the thickened capsule more or less 
deeply into the interior of the gland, the secreting tissue of which 
is atrophied, thus producing an irregularly, lobulated form of the 
liver; or as hepatitis gummosa, when the tissue of the cicatrices 
just described is seen to contain whitish or yellowish nodules, 
which usually vary in size from a linseed or a bean up to a wal- 



ACUTE YELLOW ATROPHY. G03 

nut, and resemble the nodes or gummata of syphilitic patients 
found in the subcutaneous areolar tissue beneath the peritoneum, 
in the testicles, etc. 

The symptoms during life of syphilitic hepatitis are not at all 
characteristic. A dull, temporary pain and tenderness in the re- 
gion of the liver, in rare cases jaundice, also enlargement of the 
spleen and frequently coexisting albuminuria, may hint to this 
complaint, especially when other unmistakable signs of the sec- 
ondary and tertian stage of syphilis are present. Its treatment 
belongs into the chapter of Syphilis. 

Acute Yellow Atrophy 

Is a rapid wasting of the liver in all its diameters, but especially 
in its thickness, sometimes preceded by a preliminary stage. Its 
capsule appears opaque and puckered; its parenchyma is flabby 
and shrivelled and of an ochre-yellow or rhubarb-like color; the 
blood-vessels, the gall-bladder and bile-ducts are empty in most 
cases, the gall-bladder containing only a small quantity of gray 
mucus or a turbid, pale-yellow, rarely brown or greenish fluid. 
The spleen is frequently greatly enlarged and congested and 
there are considerable extravasations of blood in various organs 
and tissues. The kidneys, especially in pregnant females, are in 
a state of fatt} r degeneration and their tissue flabby and shrivelled. 
The urine is characterized by the absence of urea, which has 
accumulated in the blood, and by temporary presence of albumen. 

The nature of this disease is still quite obscure; several theo- 
ries have been advanced, but that which considers the whole 
process as one of diffuse inflammation is the one most generally 
accepted. 

The Precursory Symptoms usually resemble the symptoms of 
an acute gastro-enteric catarrh, which sooner or later, sometimes 
not until after the lapse of several weeks, becomes associated with a 
slight jaundiced tint of the skin. Even this may exist from eight 
to fourteen days or longer before the characteristic changes in the 
liver and spleen, the haemorrhages and the nervous disturbances 
become apparent. However, in other cases, these symptoms 
appear simultaneously with the jaundice, and as soon as they do 
appear the progress of the disease is rapid and violent, terminat- 
ing in the worst cases at the end of twelve or twenty -four hours, 
in other cases after two or five days, latest and in rare cases only, 



604 LIVER. 

after a week. The disease sets in with vomiting first of ingesta 
and mucus, later of blood and ultimately of coffee-ground sub- 
stances. This is attended with headache, which, as a rule, soon 
passes into delirium, followed by convulsions and a tremulousness 
of the muscles of the extremities and trunk. Finally the state of 
excitement passes into stupor and deep coma; the pupils enlarge, 
the respiration becomes sighing, intermittent and stertorous. The 
pulse, at first slow, rises with the nervous symptoms to 120, or 
keeps at 70 or 80 as long as the patient is dozing and rises to 120 
or 130 when the patient is roused. The abdomen is tender, espe- 
cially in the hepatic region. The extent of the hepatic dullness 
diminishes as the disease advances, while that of the spleen 
increases at the same time. The bowels are almost always con- 
fined; the stools are dry and clay-like, later they become dark- 
colored and tarry from the presence of blood. There appear, as 
the jaundice increases, numerous extravasations of blood in the 
skin in the form of petechia? and ecchymoses, and ha-morrhages 
from the nose, the vagina, the stomach and bowels, and the 
bronchi. 

The urine is brown and contains bile-pigment, at times small 
quantities of albumen. Its deposit, upon exposure to cold, is 
greenish-yellow, which differs greatly from all other kinds of 
deposits. The disease is most frequently observed in the female 
sex, and then especially during pregnancy. Further are men- 
tioned as exciting causes: mental emotions, venereal excesses, 
syphilis, miasmatic influences and typhus. 

THERAPEUTIC HINTS.— Aeon., acute, feverish icterus, especially 
during pregnancy. 

Bellad., congestion to the head; headache: dizziness; sopor; 
pupils at first contracted, and afterwards dilated; spasmodic 
jerkings; grating of teeth, etc. 

Bryon., chill first and fever afterwards : typhoid symptoms : 
bitter vomiting ; constipation. 

Crot. horr., yellow color over the whole body ; convulsions with 
trembling of the limbs ; haemorrhages from all the orifices of the 
body. 

Ipec, vomiting of blood, and bloody discharges from the bowels. 

Leptand., delirium ; complete prostration ; heat and dryness of 
the skin ; coldness of the extremities : fetid and tarry stools : 
tongue thickly coated, with a black streak down the centre. 



HEPAR ADirOSUM, FATTY LIVER. 605 

Phosphor., ought to be compared. 

Compare also Haemorrhage from the Stomach and Bowels, and 
Jaundice. 



Hepar Adiposum, Fatty Liver. 

A fatty infiltration of the liver cells is found very frequently 
on post-mortem examinations without ever having shown its 
presence during life by any signs of diseased action of that organ. 
A diet of fatty substances, or of large quantities of food contain- 
ing an abundance of carbodiydrogens, produces such infiltration, 
which, however, disappears again when the food is changed. 
This accounts for the frequent occurrence of fatty liver in indi- 
viduals who have died suddenly in the bloom of good health. 
For this kind of infiltration there is no known line of demarca- 
tion between health and disease, inasmuch as the liver-cells are 
not altered by it in their character, the fat being merely deposited 
therein. Altogether different is the fatty liver as found in con- 
nection with pulmonary tuberculosis, drunkard's dyscrasia, 
chronic dysentery, cancer and other wasting diseases. Here the 
liver cells cease entirely to perform their function, their nutri- 
tion becomes impaired ; it is indeed a fatty degeneration of the 
liver-cells. Its production is not fully explained, except by the 
broad statement that it is owing to abnormal conditions of the 
metamorphosis of matter. But whether it be mere infiltration or 
degeneration, the blood is always loaded with fat and the seba- 
ceous glands of the skin secrete abundantly, causing a greasy or 
velvety character of the cutis. 

The Symptoms of fatty liver are not very well marked. Still, 
as a considerable accummulation of fat in the liver must impede 
the flow of blood through the portal vein, and the excretion of 
bile, we find fatty liver naturally associated with chronic conges- 
tion of the gastro-intestinal mucous membrane, which may be 
exaggerated by slight causes into catarrhs, derangements of di- 
gestion, diarrhoea, and haemorrhoids ; and with stools more or 
less deficient in bile ; but an intensely jaundiced color of the skin 
is never produced by it and seldom a high degree of ascites. 
The liver is at first enlarged but gradually becomes reduced to 
even below its normal size; its outer surface is smooth. The 
general appearance of the patient gradually assumes the charac- 
ters of general cachexia, and there is usually an enlargement of 
the spleen attending it. 



606 LIVER. 

Its Treatment will in the case of infiltration consist of a strict 
regulation of diet and habit, and in the case of degeneration will 
fall entirely under the treatment of those diseases with which it 
is associated. 

Colloid Liver, Lardaceous Liver, Waxy Liver, Amyloid 
Degeneration of the Liver. 

This is a degeneration of the liver cells into a waxy, translu- 
cent mass, so that by degrees the parenchyma of the gland pre- 
sents a uniform, smooth, yellowish-red, somewhat glistening sur- 
face, interrupted only by the patent orifices of the blood-vessels 
pouring out a little thin blood. This morbid change may occur 
sometimes only in isolated places, but is most frequently dis- 
tributed more or less marked throughout the entire organ. The 
nature of this substance is thus far still unknown. From the 
blue color produced by a solution of Iodine in conjunction with 
Sulphuric acid, Virchow supposed it to be an "amyloid" body, 
but the proof from elementary analysis is still wanting. 

Waxy degeneration is often found combined with fatty deposit 
in the liver, especially in cases of pulmonary tubercle, with cir- 
rhotic induration, with syphilitic cicatrices and fibroid nodules 
(gummata), with simple atrophy of the liver. It is scarcely ever 
restricted to the liver, but is almost invariably found also in the 
kidneys and spleen, and often likewise in the lymphatic glands 
and the mucous membrane of the gastro-intestinal canal. More- 
over we can usually, at the same time, discover the remains of 
chronic diseases of the bones, the indications of constitutional 
syphilis, tubercle or cancer, etc. 

The injurious effects of this degeneration upon the elaboration 
of blood and nutrition causes, as a rule, a pale, cachectic appear- 
ance of the patient and symptoms of anaemia and hydrsemia. 
The symptoms vary, however, according to the cause which has 
excited the morbid process and the direction in which it extends: 
they differ naturally in cases where the kidneys and the mucous 
membrane of the intestines are attacked at an early stage, and in 
other cases where the spleen and lymphatic glands are chiefly 
implicated. 

The liver is in most cases enlarged, at times very greatly, at 
others not at all, and in still others it is even reduced in size. 
There is usually an abnormal tenderness in the hepatic region. 



CARCINOMA HEPATIS. 607 

or a mere feeling of fulness; in rare eases of the syphilitic form an 
acute pain consequent upon an attack of peri-hepatitis. Jaun- 
dice and ascites are found only exceptionally. The spleen is 
commonly enlarged to a considerable size, though not always, 
and the derangement of the gastro-intestinal canal manifests 
itself frequently by loss of appetite, vomiting, with a clean 
tongue, diarrhoea with alternation of pale and dark stools. The 
same degeneration of the kidneys manifests itself in the majority 
of cases by enlargement and albuminuria. 

Mild cases, based upon chronic diseases of the bones, hint to: 
Calc. carb., Lycop., Silic, Sulphur. 

Syphilitic cases require; Iodium, Kali hydr. and the different Mer- 
curial preparations. Other cases will resist all treatment according 
to the base upon which they grow. 

Carcinoma Hepatis, Cancer of the Liver. 

There are three different forms of cancer of the liver: 

1. The carcinoma fasciadatum, a rare form, characterized by the 
pale, yellowish-red color, its glassy, transparent mass, which is 
enveloped in a bag of fibrous tissue. 

2. TJie alveolar cancer, the rarest of all, which is characterized 
by its jelly-like substance, developing within the areolar tissue 
around the ramifications of the portal vein. 

3. The medullary or encephaloid cancer, the most common form, 
is characterized by its marrow-like substance, which is mostly of 
a whitish color; sometimes it is red from hsemorrhagic effusion, 
and, at other times, dark, even black, from a deposition of pig- 
ment. The liver appears uneven from nodules of various sizes, 
which, for the most part, feel hard to the touch, although, in 
some cases, the sense of touch may detect fluctuation. They 
increase more or less rapidly in size, and sometimes undergo 
changes of fatty degeneration, or, in still rarer cases, of softening 
and decay, or formation of ichor. 

We do not know any cause for this malignant disease. It is 
found sometimes as a primary affection of the liver, but more 
frequently it accompanies cancerous deposits in other organs. 
Its most frequent occurrence and its most rapid development 
have been observed after extirpation of cancerous growths from 
other organs, especially from the mamma?. Persons between the 
ages of fifty and sixty are most liable to its invasion. 



G08 LIVER. 

Symptoms. — 1. Enlargement and uneven surface of the liver. Its 
size is sometimes enormous, reaching far over into the left hypo- 
chondrium and far down into the abdomen ; in fact, no other 
disease except that of colloid liver causes such extensive enlarge- 
ment of this organ. Its enormous size makes the right hypo- 
chondriac region bulge out, and its uneven surface is then easily 
detected by inspection and palpation. 

In such prominent cases there is no difficulty in the diagnosis. 
But there are cases where the cancerous nodules lie out of reach 
of palpation, either deep in the substance of the liver, or on its 
opposite surface. So is also the enlargement of the liver at the 
beginning of the disease very inconsiderable, and, in cases of few 
and small cancerous deposits, attended with general anaemia and 
marasmus, the liver may appear even smaller. 

2. Tenderness in tin- region of the liver is almost always manifest, 
at least on deep pressure, but it varies much in degree. A radi- 
ating pain towards the spine and the right shoulder-blade, as in 
other liver complaints, may be present. 

3. Icterus is present only when the situation of the tumors im- 
plicate the biliary ducts or when the cancer is associated with 
catarrh of the ducts. If once developed it never disappears. The 
skin generally presents a peculiar ash-colored, dirty-yellowish 
hue, and. being dry and brittle, peels off in minute scales. 

4. Ascites results in those cases where the morbid mass is suffi- 
ciently large, and so situated that it impedes the portal circula- 
tion, by pressure upon its vessels, or it comes and grows with 
general dropsy, or it is due to chronic peritonitis, extending from 
the liver over the peritoneum. 

5. Disturbed nutrition mid gastric symptoms are almost always 
present, but show nothing characteristic of this complaint. 

G. The spleen is very rarely enlarged. 

7. Fcirr is, as a rule, quite slight, amounting at the most to 
febrile motions. Where we find high fever, it is occasioned by 
some other complication. 

8. Hsemorrhages in the later stages we find in the interior of 
the tumor, and from this into the abdominal cavity, also from 
the stomach and intestines, from the mouth, nostrils and vagina, 
and in the form of petechia 1 and ecchymoses upon the skin, simi- 
lar to those of purpura and scurvy. 

The Diagnosis of cancer of the liver is by no means always 
easy. Where the characteristic enlargement and uneven surface 



HYDATIDS OF THE LIVER. 609 

of the liver has not yet been developed, (in the incipient state of 
the disease) or where it does not develop sufficiently to be recog- 
nized, we will have to balance the following points : 

1. Can it be colloid liver ? No ; because it is not the result of 
syphilitic or mercurial cachexia, nor is it attended by enlarge- 
ment of the spleen and albuminuria. 

2. Can it be fatty liver f No ; because it is not the result of 
tuberculosis or overfeeding. 

3. Cam, it be syphilitic inflammation of the liver ? No ; because 
there is no constitutional syphilis present. 

4. Can it be cirrhosis ? No ; because there is no enlargement 
of the spleen. 

5. Can it not be nutmeg liver ? No ; because there is no heart 
or lung disease for its foundation. After having thus narrowed 
the field of possibilities, we now observe, in addition, swollen jugu- 
lar glands, which Virchow considers of great diagnostical import- 
ance, we ascertain whether there is any cancerous formation in any 
other organ, or a hereditary tendency to it. 

Further, it is among the rarest events, that cancer of the liver 
coexists with tuberculosis, organic heart diseases, typhus or acute 
exanthematic fevers ; while, on the contrary, it is frequently as- 
sociated with other cancerous affections, especially within the 
abdominal cavity. Finally, we consider the age of the patient. 
Cancer seldom happens before the thirty-fifth year of age ; usu- 
ally between the years of fifty and sixty. 

THERAPEUTIC HINTS are rather a scarcity in this complaint. 
I do not know of a well-attested case, that ever has been made 
known as cured. The principal remedies promising the best 
alleviating results are: Arsen., Bellad., Carb. an., Conium, 
Hydrast., Lycop., Sepia, Silic, and others according to special 
indications. 

Hydatids of the Liver, Echinococcus-cysts. 

They consist of a thick, fibrous, white-glistening or yellowish 
sac of a roundish shape, and of various sizes, attaining even that 
of a child's head. The sac is lined on its inner surface by a half- 
transparent, gelatinous bladder, which contains a watery, some- 
what turbid fluid, in large quantities, and at the same time a 
number of smaller cysts, of the same structure, which again con- 
39 



610 LIVER. 

tain still smaller cysts, and so on to the fourth generation. Be- 
sides this, we observe, within these cysts and adhering to some 
part of their interior surface, groups of whitish granules, which 
are the scolices of taenia echinococcus. Under the microscope 
they appear with heads similar to that of the taenia solium or the 
common tape-worm ; having four sucking cups, in the middle of 
each of them a nozzle or snout, which is encircled by a double 
row of hooks. This echinococcus-cyst has been found in any 
and every part of the liver, sometimes singly, sometimes two, 
three or more in number. The parenchyma of the liver retains 
its integrity, and only where it is compressed by the foreign 
growth, its cells obliterate, and that part of the liver assumes, 
according to Rokitansky, sometimes a nutmeg-like appearance. 
The cysts themselves may undergo different changes. Their fluid 
contents may be converted into a. cheesy substance, whereby the 
inmates perish, or the. inner surface of the sac may become in- 
flamed and lead to obliteration of the cyst, or the cyst may burst 
and pour its contents either into the abdominal cavity, where it 
almost always causes a fatal peritonitis, or into other organs, with 
which, by previous inflammation, adhesions have been formed, 
exactly as in the case of an abscess of the liver. There are cases 
on record, where echinococcus-cysts, by perforating the dia- 
phragm, emptied their contents into the pleural cavity, from 
which they were discharged through the bronchial tubes, by 
means of abscess-formation in the lungs. There are cases also 
where they were discharged through the abdominal walls, or 
into the intestines, gall-bladder, or a large blood-vessel. Almost 
always such perforations are followed by a fatal termination, 
although, in favorable cases, where, for example, the discharge 
takes place into the intestines, or through the abdominal walls, 
the cysts became obliterated and a perfect cure followed. 

The echinococcus, when found in the liver, is also frequently 
found in other organs: the spleen, lungs, kidneys and the 
omentum. 

The essential Cause of the formation of hydatids is the swal- 
lowing of the ova or embryos of the taenia echinococcus, which 
pass from the stomach or intestine into the liver and there un- 
dergo development. This taenia echinococcus is a small tape- 
worm belonging to the dog, which explains the fact that hyda- 
tids are most frequently found in Iceland, where the dog is an 
indispensable domestic animal. 



CATARRHAL INFLAMMATION OF THE BILIARY PASSAGES. 611 

Symptoms. — Of all liver diseases this complaint causes the least 
disturbance in the system, and the occasional symptoms, caused 
by its pressure upon this or another organ, are of the least diag- 
nostic value. Only when rupture and perforation take place, we 
observe, as in the case of liver abscesses, a series of violent symp- 
toms, all of which are consequences of inflammation of those 
organs into which the perforation or rupture takes place. 

Our diagnosis is therefore confined to its physical signs alone. 
These are the following : 

1. A round, smooth, elastic swelling in the region of the liver. 

2. A sense of fluctuation on percussing the part in short, abrupt 
strokes, while the examining fingers of the other hand are held 
in close neighborhood. What Piorry has called the vibratory 
sense of hydatids is nothing more nor less than the above-men- 
tioned sense of fluctuation; ascites or ovarian cysts yield it just 
as clear, under certain conditions even clearer. 

Differential Diagnosis. — Liver abscess is attended by fever, 
pain and great constitutional disturbances. 

Distended gall-bladder is preceded by colicky pains, is usually 
accompanied by jaundice and the swelling corresponds to the 
normal position of the gall-bladder. 

Encysted pleuritic exudation does not alter the place of dull per- 
cussion sound on deep inspiration; while the outline of the dul- 
ness on percussion lowers considerably by deep inspiration in 
hydatids. 

Catarrhal Inflammation of the Biliary Passages. 

Anatomically it is characterized by similar changes as appear 
in catarrhal inflammation of other mucous membranes. Post- 
mortem examination reveals the lining membrane to be pale or 
livid, softened, tumid, and covered with a tenacious, vitreous, or 
grayish-yellow, purulent secretion, which often produces firm 
plugs of mucus in the duodenal opening of the ductus choledo- 
chus, and a total stoppage to the flow of bile into the intestines. 
These changes are particularly found in the lower portion of the 
ductus choledochus and in the gall-bladder, less frequently in 
the hepatic duct and its roots. 

In chronic cases the walls of the ducts become thickened and 
dilated, either uniformly over long tracts or in the shape of oval 
sacs. In these pools of stagnant secretion concrements are 



612 LIVER. 

sometimes deposited and in rare cases the walls of the ducts 
ulcerate. 

Catarrhal inflammation of the biliary passages is most frequently 
induced by inflammation of the stomach and intestines, some- 
times by hypersemia and chronic inflammation of the lower, and 
more rarely, by fatty and waxy degeneration. Its Symptoms cor- 
respond, therefore, with the symptoms of those ailments of which 
it is the result, always associated with the symptoms of more or 
less intense jaundice and tenderness in the region of the liver. In 
a few cases the gall-bladder can be felt as a pear-shaped tumor 
at the margin of the liver. The jaundice lasts in most cases for 
some time after the gastric symptoms have disappeared. In cases 
dependent upon diseases of the hepatic parenchyma, the jaundice 
is of a fainter tint, and the digestion suffers less, but the symp- 
toms are more apt to return. 

THERAPEUTIC HINTS.— Compare catarrh of the stomach and 
intestine, also jaundice and the other affections of the liver. 

In children the following are most frequently indicated : 
Chamom., or Merc sol. Besides compare Bellad., Bryon., Nux vom., etc. 

Cholelithiasis, Gall-Stones. 

Gall-stones are made up of substances which are all contained 
in a state of solution in normal bile, with the exception of epi- 
thelium and mucus, both being furnished by the mucous mem- 
brane of the biliary passages. The principal constituent of gall- 
stones is cholesterine, although it is only sparingly contained in 
the bile; but in virtue of its insolubility it contributes, as uric 
acid does to the formation of urinary calculi, the main portion to 
the formation of gall-stones. Other constituents are the bile-pig- 
ments (cholepyrrhin of a brownish, cholechlorin of a green color) 
and their combination* with lime, the biliary acids and tJtcir calcare- 
ous salts, fatty acids and soaps, mucus and epithelium, uric acid and 
earths. 

In the biliary passages gall-stones occur in most cases, in 
numbers from five to ten or thirty, and occasionally even to 
more than a thousand. All of them which thus occur together, 
have almost invariably the same characters and composition, in 
as much as all of them owe their origin and growth to the same 
morbid process; still exceptionally dissimilar calculi have been 
found in the same gall-bladder. Their size varies from that of a 



CHOLELITHIASIS. 613 

millet-seed to that of a hen's egg; their form is primarily globular, 
but changes during their subsequent growth in many ways; very 
huge stones usually assume an egg-shaped or cylindrical form, 
corresponding to the form of the gall-bladder; some stones pre- 
sent a warty or mulberry form, others but rarely found, are flat- 
tened, leaf-like concretions with black, metallic glistening sur- 
faces, and still others are the branched varieties which form a 
cast of the bile-ducts in which they are developed. Their color 
is in most cases brownish or greenish-yellow, but all shades of 
color are met with, from snow-white to coal-black. Their specific 
gravity is heavier than water, but dried specimens will float on 
water because the} r contain air. Their structure varies exceed- 
ingly. In simple homogeneous calculi it is of a uniform texture, 
and presents an earthy, saponaceous, or crystalline fracture, ac- 
cording to their composition of earthy matter, or of bile-resin 
and its calcareous compounds, or of pure crj-stallized cholesterine. 
In compound calculi, we observe a central portion or nucleus, a shell 
of greater or less thickness surrounding the nucleus, and an 
outer crust covering the shell. The nucleus consists either of the 
compound of cholepyrrhin and lime, or of foreign bodies (a small 
clot of blood, a worm, a needle, a plum-stone). The shell is usu- 
ally striated, and consists of crystals of cholesterine, or in rarer 
cases it surrounds the nucleus in concentric laminse, like the 
layers of an onion, or it is devoid of all structure, of a soapy or 
earthy character. The external crust is of various thickness; it 
covers the shell either in a uniform manner, or is thicker on one 
portion than on the other; it is not unfrequently covered with 
warty prominences, and its composition and color varies greatly 
according to the constituents of which it is composed. 

In addition to the gall-stones proper, pulverulent or gritty de- 
posits, similar to those which are met with in the urinary pas- 
sages, are found in the excretory apparatus of the liver. 

Not unfrequently gall-stones exhibit indications of commenc- 
ing disintegration; their angles and edges disappear, and their 
substance is eaten away by erosions, resembling caries of the 
teeth, penetrating through several layers, an effect undoubtedly 
produced by chemical action. Gall-stones may also be destroyed 
by cleaveage. 

Their mode of origin is still not fully explained. However, 
stagnation and decomposition of bile seem to constitute the primary 
cause of the formation of gall-stones. The stagnation of bile is 



614 LIVER. 

favored by repeated attacks of catarrh of the biliary passages, by 
cancer of the liver and other hepatic affections, and also by sed- 
entary habits of life. The decomposition of bile is dependent 
upon physiological processes the nature of which has thus far not 
been revealed. The tendency to gall-stones increases with the ad- 
vance of life; before thirty years of age they are rarely observed. 
Females are more liable to gall-stones than males. 

Gall-stones are found rarely in the hepatic duct and its 
branches, but most frequently and in largest numbers in the 
gall-bladder, which they may leave by passing through the cys- 
tic duct into the ductus communis and from this into the duode- 
num ; or they may escape by fistulous openings into the stomach 
or intestine, or externally through the abdominal wall. Through 
the ductus choledochus all concretions pass which leave the liver, 
whether they have their origin in the hepatic duct or in the gall- 
bladder; they, as a rule, obstruct the duct and interrupt the 
excretion of bile. 

Symptoms. — Gall-stones may lie for years in the gall-bladder 
without giving rise to an} r symptoms whatever. But if they are 
washed from the gall-bladder into the cystic duct, they cause, 
unless they are very small, the most violent symptoms, known 
under the name of " Gall-stone colic." Usually a few hours after a 
meal, when the contents of the gall-bladder are poured into the 
duodenum, or in consequence of lifting a heavy load, or after 
mental emotions, an excruciating pain, of a boring and burning 
character, is felt in the right hypochondrium and epigastrium, 
radiating down to the navel, back to the spine, upwards into the 
chest, to the shoulder-blades and neck, and even down the arms 
to the very fingers' ends-. The slightest touch increases the pain. 
It is attended with vomiting, great restlessness, singultus, even 
convulsions, delirium, syncope and speechlessness. In some 
cases the attack commences with rigors, often followed by heat 
and sweating, the temperature rising to between 99.5° and 104.9° 
F., and the pulse to between 92 and 120. Often er, however, the 
pulse is small and of normal frequency, or even slower than nor- 
mal. Jaundice is absent at first, or only slight, and becomes 
marked only when the calculus fills up the ductus choledochus. 
The duration of hepatic colic varies greatly ; it may pass off in a 
few hours, or last for many days. In the latter case the pain re- 
curs in paroxysms until the duct becomes so far dilated as to 
permit the calculus to pass. Sometimes the calculus, after enter- 



CHOLELITHIASIS. 015 

ing the cystic duct, may return into the gall-bladder, when the 
pain likewise ceases, and in such cases no concretions are found 
in the stools. But when the calculus remains firmly impacted 
in the cystic duct, and completely closes up the neck of the gall- 
bladder, the colicky pains gradually subside, and there only re- 
mains a. sensation of tightness or pricking, while the gall-bladder, 
incapacitated of emptying itself, gradually becomes largely dis- 
tended (Hydrops cystidis fellese), which may terminate at last in a 
destruction of this organ and consequent fatal peritonitis. 

Stones in the ductus choledochus usually excite less pain on 
account of the greater capacity of this duct, and when entering 
the ductus communis the pain ceases altogether; but reaching 
the abdominal opening, the pain returns with renewed severity 
until the excretions have passed into the intestine. As long as a 
stone remains in the ductus choledochus, the bile is more or less 
completely shut off from the bowel, and jaundice makes its ap- 
pearance, growing the more intense the longer the obstruction 
lasts. 

The Diagnosis is easy, where we find the gall-stones passed off 
in the stools, or where we can feel them in the gall-bladder. The 
whole row of symptoms as described above is characteristic. 
Jaundice, although not a constant symptom, is nevertheless con- 
nected with the other symptoms of great diagnostical value. 

THERAPEUTIC HINTS.— BeUad., during the colic, is the most im- 
portant remedy. 

Baptis., pain in the region of the gall-bladder, forcing the pa- 
tient to stir about, although motion is painful. 

Berber., has been advised as curing quickly and permanently. 
(J. Angell.) 

Chelid., with pain through under the right shoulder-blade. 

China, is indicated by "all the symptoms which arise from ob- 
struction in the gall-bladder; the colic; the periodicity of its re- 
currence, though the periods of its return are often very unequal 
and irregular; the yellowness of the skin and conjunctiva; the 
constipated state of the bowels; the scybalated character of the 
dark, greenish stools, the scybala varying in size from that of the 
largest nutmeg to that of sheep-dung, and even smaller than the 
smallest peas." " I give usually China 6 , six pills twice a day, till 
ten doses are taken ; then six pills every other day till ten doses 
are taken, etc., till at length the dose is taken only once a month." 



G16 LIVER. 

"I have not failed in a single instance to cure, permanently and 
radically, every patient with gall-stone colic who has taken the 
remedy as above directed." (David Thayer.) 

Coloc, twisting, boring pain in the stomach, relieved by press- 
ure; rending, tearing pain, extending up to the right mamma; 
nausea with coldness of the extremities. (R, Arnold.) 

Caesium. (Baruch). 

Besides these the following remedies have been recommended : 
Alum., Apomorph., Arsen., Calc. carb., gall-stones triturated (German 
physicians), Card, mar., (Rademacher), Chionanthus, Evon., 
Chlorof., Hepar, Laches., Lycop., Mercur., (Porges), Nux mosch., 
Nux vom., Opium, Osmium, Podoph., Silic, Sulphur, Tereb., 
(Mossa), Thuja, Yer. alb. 

Olive oil is believed to dissolve some kinds of gall-stones, if 
taken in doses of three to four ounces each night for four nights. 
(C. D. Fairbank.) 

Thrombosis and Occlusion of the Portal Vein ; Pylethrom- 
bosis ; Pylephlebitis Adhaesiva Chronica. 

The portal vein derives its venous blood from the stomach, in- 
testines, spleen and pancreas. It is divided into two chief 
branches for the right and left lobes of the liver in front of the 
transverse fissure. These two branches are further subdivided 
till they finally end in the terminals, or the so-called interlobu- 
lar veins, from which the capillary system of the hepatic lobules 
originates. From the capillaries of each acinus the blood is car- 
ried by the so-called vena centralis lobuli into the hepatic veins, 
and from the latter into the inferior vena cava. The radicles, 
trunk, and the hepatic ramifications of the portal vein are all 
destitute of valves. The blood flows in the portal vein under 
very slight pressure and with slight rapidity. Stasis of blood in 
its territory, therefore, occurs very readily, giving rise to ectasia, 
dilatation, and sinuosity of the vessels, and to coagulation of the 
blood contained in them. In addition to the slight vis a tergo, 
inspiration acts as a motive force, accelerating the blood-current 
in the portal vein, while expiration rather retards it. 

From this it may be seen that coagula or thrombi may be de- 
veloped in the portal vein as well as in other parts of the venous 
system. Their most frequent Causes are local disturbances of 
the circulation of blood, resulting from granular induration, cir- 



PYLEPHLEBITIS SUPPURATIVA. 017 

rhosis and chronic atrophy of the liver, by which a destruction of 
numerous capillaries or a constriction of the branches of the por- 
tal vein is induced. 

Less often the same effect may be produced in consequence of 
weakened force of the circulation, from diminished action of the 
heart, or from marasmus, and cases have also been observed 
where thrombosis of the portal vein was the result from com- 
pression of the vessel below the liver by contractile connective 
tissue, and by tumors of various kinds. 

The Symptoms of occlusion of the portal veins are, besides 
those which are characteristic to the diseases which lead to it: 
ascites, which in a few days attains an extraordinary amount, and 
which immediately returns after the performance of paracentesis; 
the superficial veins of the abdominal parietes enlarge and ex- 
tend in the form of thick cords from the abdomen over the 
lower part of the thorax towards the axillae; the spleen increases 
in size; diarrhoea supervenes, of a watery, or often bloody char- 
acter, not unfrequently accompanied by vomiting; the urine is 
scanty and dense; the patients decline rapidly, and present a 
pale, cachectic appearance. The termination of the disease is, 
perhaps, without exception, fatal. 

Pylephlebitis Suppurativa, Purulent Inflammation of the 
Portal Vein, 

In this affection the thrombus softens from the centre into a 
dirty grayish-red pulp and afterwards dissolves more or less 
completely into a purulent fluid. The wall of the vein is thick- 
ened, softened, and infiltrated with exudation; its inner coat is 
discolored, red, brownish, or greenish-yellow, wrinkled, and not 
unfrequently torn and covered with fibrinous layers, or fluid 
pus. These alterations may spread to the hepatic branches of 
the portal vein, and even to its roots. 

It may be Produced by a direct lesion of the vascular walls, 
(traumatic pylephlebitis) to which the pylephlebitis of the new- 
born belongs starting from the umbilicus; or by an inflamma- 
tory or ulcerative focus within those organs from which the 
radicles of the portal vein start; or by suppuration in the vicinity 
of the caecum and its vermiform appendix (perityphlitis); or by 
a purulent or ichorous focus in the spleen; or by purulent de- 
posits between the layers of the mesentery, due to disease of the 



618 LIVER. 

lymphatic glands ; or by diseased conditions of the liver, the bil- 
iary passages, or in Glisson's capsule and the hepatico-duodenal 
ligament. 

Besides the Symptoms which belong to the disorders of which 
pylephlebitis is the result, its commencement is marked by pains 
in the epigastrium, the right or left hypochondrium, the caecal 
or umbilical region, according as the trunk or one of the radicals 
of the vein is first diseased. This is soon followed by rigors, 
heat and- profuse sweating, often recurring without any certain 
type. Liver and spleen, as a rule, increase in size, and the skin 
and urine become jaundiced. The stools are copious, thin and 
bilious, only exceptionally constipated. Later symptoms of dif- 
fuse peritonitis, painful distention of the abdomen, vomiting, etc., 
usuall} r supervene; the patients rapidly lose flesh and strength; 
the fever assumes a hectic character, and ultimately delirium or 
somnolence is developed and terminates in death. This series 
of symptoms may run its course in one or two to four or six 
weeks, oftentimes with several deceitful remissions. If its de- 
velopment could not be prevented its cure will scarcely be pos- 
sible. 



Icterus, Cholaemia, Jaundice. 

Jaundice is not a disease, but only a symptom, and consists of 
a yellow discoloration of the skin by the deposition of the color- 
ing constituents of bile, namely: biliary pigment, biliphaein, 
cholepyrrhin. 

The so-called liver-spots (chloasmata, macular hepatica?) have 
no relation to the diseases of the liver, but are partial deposits of 
pigment from various causes; and in some cases yellow discolor- 
ation is a disease of the skin of the chest, pityriasis versicolor, 
which consists of vegetable parasites. The yellow discoloration 
of icterus varies greatly in degree, from a slight and light yellow 
through all shades to a blackish and greenish-brown color. 

It is now conceded on all sides, but still not fully explained by 
experiments, that jaundice may originate in two different ways. 
First, by obstruction to the escape of bile from the secreting 
gland (hepatogenous chohzmia), and secondly, by some alteration 
in the metamorphosis of substances contained in the blood 
(hsematogenous cholaemia, or blood icterus). 

1. Hepatogenous cholsemia which owes its origin to a mechanical 



ICTERUS, CHOL^MIA, JAUNDICE. G19 

impediment to the excretion of bile, and its resorption into the 
blood, is the best understood form of the two. The passage of 
the bile into the circulation seems, according to recent demon- 
strations, to take place almost exclusively by way of the thoracic 
duct, which would afford additional support to the theory, that 
there is between the secretory cells and the blood-capillaries of 
the liver, quite an extensive system of channels for the flow of 
lymph, and obviate at the same time the difficulty of under- 
standing the mode how the bile could be infiltrated into the 
blood-capillaries which are everywhere separated from the gall- 
capillaries by the cellular substance of the liver. 

The Causes, of which stagnation of bile is the result, are very 
manifold. The ductus eholedochus and hepaticus may become ob- 
structed ; by catarrh of their lining mucous membrane, as in 
icterus eatarrhalis; by accumulation of faecal matter in the large 
intestines, or a pregnant uterus ; by enlargement of the lymphatic 
glands in the fissure of the liver from lardaceous, tubercular, or 
cancerous infiltrations; by concretions in their own channel, 
usually attended with colic ; by adhesions of their walls in con- 
sequence of exudative processes ; by carcinomatous growths from 
the lining mucous membrane of their walls, or of the pylorus, of 
the duodenum, of the head of the pancreas, or by tumors in the 
liver. 

The biliary passages within the liver may become compressed, or 
constricted by a large number of morbid alterations of the liver, 
such as cancer, echinococci, cirrhosis, etc; by stagnation of blood 
in the hepatic vein in consequence of organic cardiac diseases, 
and diseases of the lungs and pleura, in which affections the ac- 
celeration or retardation in the respiratory movement of the dia- 
phragm exerts also a great influence, which may be sufficient to 
cause an obstruction to the flow of bile. 

The Symptoms of a stoppage of bile and its accumulation in 
the blood, manifest themselves in a jaundiced discoloration of 
the liver, of the serous exudations, and of the secretions, especi- 
ally those of the kidneys and skin. The urine becomes saffron- 
yellow, reddish-brown, dark brown, greenish-brown, or brownish- 
black, according to the quantity and quality of the bile-pigment 
which enters into it. The best reagent is nitric acid which is not 
altogether free from nitrous acid. By adding the concentrated 
acid, drop by drop into a small glass containing urine, the well- 
known play of colors from brown to green, blue, violet and red 



620 LIVER. 

will be seen arranged in layers, one above another, like a rain- 
bow. The siveat, especially of the axilla, colors the white linen 
yellow, and so also have the sputa in bilious pneumonia a brown, 
or usually, a leek -green color. With this tinging of the secre- 
tions with pigment goes hand in hand the discoloration of the 
tissues. The shin assumes a pale, sulphur yellow, later a saffron 
or citron yellow, or an olive or bronzed color, according to the 
intensity and duration of the disease. This discoloration is seen 
first on those places where the epidermis is thin, for instance on 
the nose-wings, the angles of the mouth, the forehead and neck. 
As the coloring proceeds from the deeper layers of the epidermis, 
the yellow color of the skin remains until desquamation of the 
epidermis has been accomplished, which does not take place 
sometimes till long after the removal of the causes of the jaun- 
dice and the disappearance of the Coloring-matter from the urine. 
The mucous membranes become only slightly tinged, but the col- 
oring matter penetrates into all tissues: the adipose cellular tissue, 
the serous and fibrous membranes, the areolar tissue, the walls of 
the blood-vessels and of the lymphatics, and the substance of the 
bones and of the teeth. The cartilage, brain and nerves are less 
affected. When the brain appears yellow, the discoloration pro- 
ceeds from infiltration of the cerebral substance with yellow 
serum. In the eye the jaundice color extends over all mem- 
branes, humors, and especially the vitreous body. In pregnant 
women even the foetus participates in the yellow color. The 
nervous system exhibits occasionally the following abnormal con- 
ditions: Itchiness of the skin; derangement of the general sensations, 
such as sadness and peevishness of temper, headache, giddiness, 
great exhaustion and debility; yeUow sight or xanthopsy, bitter 
taste by clean tongue; slow pulse, in most cases 50 or 40 beats in 
a minute, in some cases still lower; the temperature in simple 
cases remains unchanged. 

The symptoms of the digestive organs, the most important in a 
practical sense, is the change in color of the faeces. A total 
absence of bile makes the stools ash or clay-colored, with a ten- 
dency to constipation ; a partial want of bile merely makes them 
paler than usual. 

The Duration and Prognosis of jaundice depends principally 
upon its primary causes. 

2. Hematogenous cholaemia, blood-icterus, seems to be caused by 
some alteration in the metamorphosis of substances contained in 



ICTERUS, CHOL^MIA, JAUNDICE. G21 

the blood not fully understood yet ; it runs its course indepen- 
dently of any influence exerted by the liver and without any 
detectable mechanical impediment to the excretion of bile. To 
this class belong jaundice from the effects of ether, chloroform 
and Pbosphorus, from snake-bites, from pyseinic infection of the 
blood, from swamp fever, typhus and relapsing fever, and from 
yellow fever. 

Jaundice from violent mental emotions, especially vexation, anger, 
fright, etc, seems likely to be produced by interruptions to the 
circulation of blood through the liver in consequence of the 
influence of the nerves exerted over the calibre of the branches of 
the portal vein, and by interruptions to the heart's action, the 
respiratory movements and the renal secretion. 

Icterus menstrualis is probably produced by sudden changes in 
the blood-pressure in the portal vein. 

Icterus gravidarum, which makes its appearance in the later 
months of pregnancy, is produced by the pressure of the dis- 
tended uterus, or by accumulation of fsecal matter in the colon, 
upon the biliary ducts, or it is characterized by serious derange- 
ments of the nervous system, and, so far as cases of this kind have 
as yet been examined, depends upon acute atrophy of the liver 
and diseased kidneys. 

Icterus neonatorum appears soon after birth and in ordinary cases 
seems to be produced by the diminished tension of the capillaries 
in the hepatic tissue, which takes place upon the stoppage of the 
influx of blood from the umbilical vein, and which gives rise to 
an increased transfusion of bile into the blood. A graver form is 
that in consequence of phlebitis umbilicalis followed by puru- 
lent infection. In some cases it may be produced by a catarrh 
of the duodenum or an accumulation of mucus within the gall- 
ducts. 

Jaundice of new-born children must not be confounded with 
the slight yellowish discoloration of the skin, which, in most 
children, is seen a few days after birth and is nothing but a 
change of color of the hsematin, which, in consequence of the 
great hypera3mia of the skin after birth, becomes deposited in the 
skin. In such cases the yellow color of the white of the eye is 
absent. 

THERAPEUTIC HINTS.— Aeon., pain changing about from the 
stomach to the liver, or to the navel ; fever, great thirst ; catarrh 



622 LIVER. 

of small intestines; constipation or diarrhoea, sometimes in alter- 
nation ; during pregnancy ; in new-born children ; after fright. 

Arsen., in different liver affections; in consequence of inter- 
mittent fevers; heat, restlessness, anxiety, irritable mood alter- 
nating with low-spiritedness. 

Aurum, pain in the liver and upper part of the abdomen; 
bowels constipated ; stool grayish, ashy ; urine scanty, green, 
brownish ; lower extremities, from the knees down to the feet, 
painful and tired. 

Bellad., after the abuse of Peruvian bark or mercury ; in com- 
plication with stones in the gall-bladder ; hardness of the liver ; 
congestion to the head. 

Berber., spells of icterus with pale, tough alvine discharges, or 
profuse, acrid, watery diarrhoea ; urine dark, turbid, with copious 
sediment ; morbid hunger alternating with loathing of food, or 
great thirst alternating with aversion to all kinds of drink ; con- 
stant, troublesome bloatedness of the abdomen, with occasional 
forcible and noisy discharge of flatus. 

Bryon., stitching pain on pressure in the liver ; pressure in the 
pit of the stomach ; pain in the limbs, worse from motion ; ob- 
stinate constipation; thick, white, coated tongue; nausea; gag- 
ging ; vomiting after eating and drinking ; general malaise ; 
disinclination to move. 

Calc. carb., stitches in the liver during or after stooping ; cannot 
bear tight clothing around the waist ; enlargement of the liver ; 
habitual constipation ; grayish, whitish feces ; indigestion ; pit of 
the stomach swollen out like a saucer turned bottom up. 

Card, mar., in complication with gall-stones ; great sensitiveness 
of the head to cold ; loss of memory and smell ; colicky pains in 
the stomach, with waterbrash ; vomiting. 

Carb. veg., psoric taint ; scorbutic and intermittent fevers : ca- 
chexia ; irritable, vehement disposition ; loathing of meat, butter, 
fat ; constipation, or pale, whitish stools ; dark red, bloody-look- 
ing urine. 

Chamom., after chagrin, imprudent diet, or taking cold ; in new- 
born children. 

Chelid., pain in the liver, and in the back under the lower corner 
of the right shoulder-blade; very irregular pulsations of the heart. 

China, gastro-duodenal catarrh, particularly after great loss of 
animal fluids, or after heavy illness ; dulness and muddled con- 
dition of the head ; oppressive, tearing headache, particularly at 
night ; restless, unrefreshing sleep ; yellow coating of the tongue : 



ICTERUS, CHOL-ffiMIA, JAUNDICE. 623 

dry lips; loss of appetite; loathing of meat; loathing, and yet 
canine hunger; hitter or sour eructations and taste; gagging; 
oppression of the stomach and chest, especially after eating; fre- 
quent whitish stools; emission of fetid flatulence without relief; 
great languor, out of humor, and vehement. Gall-stones. 

Conium, hard swelling of the liver; glandular swellings else- 
where ; the flow of urine stops suddenly, but continues again 
after a while ; cough worse after lying down. 

Digit, constant nausea and gagging, with a clear tongue covered 
with white slime; soreness and bloatedness of the pit of the stom- 
ach ; soreness and hardness in the region of the liver ; stool de- 
layed, chalky; urine scanty, thick, turbid, blackish; pulse full, 
slow ; chilliness and shuddering alternating with heat ; tearful, 
low-spirited. 

Pel tauri, violent pain in the bowels with thin stools, which 
are followed after straining by crumbling masses. 

Gelsem., prostration ; clay-colored, creamy stools. 

Hepar, especially after mercurial poisoning. 

Hydrast, gastro-duodenal catarrh; sense of sinking and pros- 
tration at the epigastrium, with violent and continued palpita- 
tion of the heart. 

Ignat, silent melancholy; twitching of one muscle at a time. 
(Cushing.) 

Iodium, dirty, yellowish skin ; great emaciation ; downcast, irri- 
table mood ; yellow, almost dark brown, color of the face ; thick 
coating of the tongue; much thirst; intense canine hunger all 
the time, with vomiting after eating; white diarrhceic stools al- 
ternating with constipation ; dark, yellowish-green, corroding 
urine: after mercurial poisoning; organic lesions of the liver; 
dyscratic states of the system with hectic fever. 

Kali carb., swelling of the liver; stitch-pain in the right side of 
the chest through to the shoulder; pressive, sprained pain in 
the liver ; can lie only on the right side ; complete exhaustion ; 
neither thirst nor appetite; purulent sediment in the urine; ab- 
scess of the liver. 

Laches., in different liver complaints ; during the climacteric 
age ; after intermittent fevers ; pain as if something had lodged 
in the right side, with stinging and sensation as if forming into 
a lump moving towards the stomach ; inability to bear anything 
tight around the waist, not even the pressure of the night-jacket ; 
pain when coughing as if ulcerated. 



624 • LIVER. 

Leptand., full, aching pain in the region of the gall-hladder; 
hot, aching pain in the liver extending to the spine; with chilli- 
ness along the spine; clay-colored diarrhoea. 

Lycop., chronic liver complaints; after fright; obstinate consti- 
pation; incarcerated flatulence; chronic intestinal catarrh. 

Magn. mur., chronic hard swelling of the liver, with pressive 
pain extending to back and stomach; face dirty, dark yellow; 
tongue dirty, yellowish ; bowels distended and hard with press- 
ure and heaviness; stool hard, gray; urine turbid; dyspnoea; 
palpitation of the heart; oedema of the feet up to the calves of 
the legs ; weak, emaciated ; fearful, easily frightened. 

Mercur., one of the most frequently indicated remedies, with 
and without fever ; duodenal catarrh, with thickly coated, flabby 
tongue, showing the imprints of the teeth: bad smell from the 
mouth; nausea, loathing; vomiting; soreness in the region of 
the liver; diarrhoea; gall-stones; jaundice of new-born children; 
after abuse of Peruvian bark. 

Myrica cerif., dragging pain in the back ; miserable feeling all 
over; dull pain in the hepatic region; tongue thickly coated of a 
dirty white or yellowish color: no appetite, loathing of food, 
strong desire for acids; sleeplessness, unrefreshing sleep. 

Nitr. ac, in consequence of chronic derangements of the liver; 
costiveness; great tearing pain in the rectum, continuing a long- 
time after stool, even more intense after a loose stool. 

Nux vom., gastro-duodenal catarrh: after allopathic dosing, 
overloading the stomach, the use of coffee, liquor, in sedentary 
habits, after anger. In complication with gall-stones. Headache, 
dizziness, loss of appetite, bitter taste: nausea, vomiting, gagging: 
pressure in the stomach, better from belching, soreness of pit, 
stomach and bowels; unsuccessful urging to stool, constipation. 
Itching of the skin in the evening; restless sleep; wakes about 
three or four o'clock in the morning and falls again into a heavy, 
unrefreshing morning sleep; peevish, irritable. 

Phosphor., in complication with pneumonia or deep-seated brain 
diseases. Atrophy of the liver; during pregnancy, with dry 
cough and involuntary discharge of urine: constant chilliness, 
even in a warm room ; dejected spirits: aphonia and hoarseness. 

Plumbum, nausea in evening or at night, vomiting of food : rest- 
less, broken sleep. 

Podoph., in complication with gall-stone; then the pain extends 
from the region of the stomach towards the res-ion of the gall- 



ICTERUS, CHOLyEMIA, JAUNDICE. 625 

bladder, and, when at its height, is mostly attended with exces- 
sive nausea; or in complication with inflammatory or hyperaemic 
states of the liver; then there is a fulness, with pain and sore- 
ness, in the right hypochondrium; chronic costiveness or alter- 
nate constipation and diarrhoea. 

Pulsat, in consequence of chronic susceptibility to hepatitis and 
derangement of the secretion of bile, with looseness of the bowels ; 
duodenal catarrh ; disordered digestion ; feverishness and thirst- 
lessness ; after quinine. 

Rheum, in consequence of eating unripe fruit, and accompanied 
with white diarrhoea. 

Sepia, with pain confined to the liver; yellow saddle across the 
bridge of the nose ; brown, yellowish color of the eyelids. 

Silic, hardness and swelling of the region of the liver ; throb- 
bing, ulcerative pain in the right hypochondrium, increased by 
contact and walking. 

Sulphur, in psoric persons, with or without hardness and swell- 
ing of the liver ; vomiting of ingesta or blood ; pain in the pit of 
the stomach and right hypochondrium ; abdomen bloated ; stool 
constipated; sleeplessness; nightly itching of the skin; hectic 
fever ; red lips. 

According to Hartman compare, if icterus be caused by chagrin 
or anger: Aeon., Bryon., Chamom., China, Ignat, Nux vom., 
Natr. mur., Sulphur. 

By taking cold in consequence of sudden changes of temperature : 
Dulcam., Nux vom., Chamom., Merc. sol. 

By improper food and overloading the stomach ; Pulsat., Ant. 
crud., Bryon., Carb. veg., Chamom., Natr. carb., Nux vom. 

By the abuse of chamomile tea : Ignat., Nux vom., Pulsat., China. 

By the abuse of mercury : China, Hepar, Sulphur, Nitr. ac, Asaf., 
Iodium, Arsen. 

By the abuse of Peruvian bark: Pulsat., Arsen., Mercur., Ipec. 

If being attended with much flatulence, according to Bcenning- 
hausen: Carb. veg., Chamom., China, Ignat., Lycop., Nux vom., 
Plumbum. 

DISEASES OF THE SPLEEN. 

Physical Examination. — When of normal size — which in an 
adult is as follows : length, four to five inches ; breadth, three to 
four inches ; thickness, one to one and a half inches — the spleen 
40 



626 SPLEEN. 

yields on percussion a dull sound, bounded as follows : posteriorly 
by the body of the eleventh dorsal vertebra ; in front by a vertical 
line drawn from the anterior border of the axilla to the free end 
of the eleventh rib ; superiorly by the ninth rib ; and inferiorly 
by the free end of the eleventh rib. In order to obtain a clear 
result by percussion the patient ought to be placed upon his right 
side. It must likewise be considered whether the stomach be not 
filled at the time of percussion. In cases of accumulation of fluids 
in the, left thoracic cavity, either pleuritic or pericardial, in accu- 
mulation of gas, abdominal or thoracic, in tumors of neighboring 
organs (liver, omentum, kidney), it may sometimes be next to 
impossible to define the size and position of the spleen. 

A considerably enlarged spleen, however, under ordinary cir- 
cumstances is easily detected by percussion. And it is sometimes 
enormously enlarged and displaced, reaching inferiorly to the os 
pubis, and anteriorly to the median line of the abdomen; in 
some cases even filling almost the whole abdominal cavity. 

In such cases it is also accessible to palpation. Even a moder- 
ate enlargement may be felt, if it extend below the eleventh rib. 
Its surface, except when invaded by cancer, is always smooth ; 
and its form oval and sometimes wedge-shaped. Its rounded 
apex, and the notch which corresponds to the middle line of the 
spleen, and which becomes the more marked the larger the spleen 
grows, are characteristic signs by which to distinguish it from 
any other abdominal tumor. 

Notwithstanding great and laborious experiments, we know as 
yet but little concerning the functions of this organ. Only so 
much seems to be certain, that it bears an important relation to 
the formation of white blood-corpuscles, although we do not 
know how and in what manner. And this seems to be corrobo- 
rated by the fact, that diseases of the blood always affect the 
spleen, altering it in size and consistence and, vice versa, that last- 
ing diseases of the spleen lead to a diseased state of the blood, 
causing anaemia, leucaemia, hydrops, scurvy. 

Cases in which such a connection does not seem to exist, prove, 
perhaps, only that the function of the spleen may, under certain 
circumstances, be performed by some other organ or organs in- 
stead. 



ANATOMICAL PECULIARITIES OF THE SPLEEN. 627 

Anatomical Peculiarities of the Spleen. 

It consists of a much softer and looser texture than any other 
glandular organ of the bod}' ; its areolar framework is made up 
of the elastic tunic which forms sheaths for the vessels in their 
ramifications through the organ, which again are loosely con- 
nected by small fibrous bands, issuing in all directions from said 
sheaths. In this way a multitude of interstices is formed, which 
contain a soft, granular substance. This peculiarly loose con- 
struction makes the organ pre-eminently fit for the reception of 
large quantities of blood ; and the more so as its capsule is also 
of a yielding nature, offering little resistance to extension ; so 
that, on the other hand, if once overdistended, it regains its pre- 
vious normal state very slowly ; and this on account of the in- 
elasticity of its tissue. The veins of the spleen constitute, by 
their numerous dilatations, the principal part of its bulk ; they 
pour their blood, after uniting with the veins in the stomach, 
and other less important vessels, into the portal vein. 

The wdiole organ is held loosely in its position by a duplica- 
ture of the peritoneum. 

The knowledge of these anatomical peculiarities of the spleen 
at once explains its participation in various abdominal and pec- 
toral affections. All hepatic troubles, and all diseases of the 
heart and lungs which obstruct the portal circulation, must ne- 
cessarily retard or prevent the normal egress of blood from the 
spleen, and cause it to swell ; a stagnation of blood in the splenic 
vein must cause a like stagnation in the veins from the stomach, 
and thus bring on vomiting of blood, and its loose connection 
explains at once the possibility of its sinking quite low down 
into the abdominal cavity under certain circumstances. 

Haemorrhagic Infarction, Splenitis, Lienitis or In- 
flammation of the Spleen. 

Hemorrhagic infarction is of much more frequent occurrence 
in this organ than in any other. It consists of a blocking-up of 
the smaller splenic arteries by fibrinous coagula, wdiich have 
formed in the left ventricle of the heart in consequence of endo- 
carditis, and which have been washed away by the stream of 
blood, and carried through the splenic artery into its smaller 
branches, w T here they stick fast. This is of such frequent occur- 



628 SPLEEN. 

rence that it is very rare not to find hemorrhagic infarction in 
the spleen, in all cases where post-mortem examination reveals 
valvular destruction to any considerable degree; much more 
rarely, such emboli come from gangrenous places of the lungs. 
In such cases they have to pass through the pulmonary veins, 
the left ventricle, aorta and splenic artery. Hemorrhagic in- 
farction forms also in consequence of malarial infections, typhus, 
septicaemia, and acute exanthematic fevers; in these cases, it 
seems, by a stagnation of circulation within the splenic veins. 
These hsemorrhagic coagula, or thrombi are usually situated at 
the periphery of the spleen, and are roundish or wedge-shaped, 
their broad base being nearest to the periphery, while their apices 
point toward the interior. 

They appear at first of darker color and harder than the sur- 
rounding tissue, which appears- perfectly sound. By-and-by, 
however, they become discolored and changed into a yellow, firm, 
homogeneous mass, which during the further progress of the dis- 
ease may undergo several changes. It may shrink and leave a 
cicatrix, or suppurate and form abscesses of the spleen, which, if 
they are many, may transform the whole spleen into a mass of 
corruption. 

These abscesses again may go on to different terminations. 
They may, b} r fibrous exudation, become encysted, or they may 
cause pyaemia, or they may burst and discharge their contents, 
like abscesses of the liver, into the peritoneal sac; or when adhe- 
sions have been formed with neighboring organs, they may, by 
perforation, discharge their contents into the stomach, colon, or 
the pleural cavity. 

A primary inflammation of the spleen is of very rare occurrence; 
even external injuries, a blow, a fall, a wound, are apt to cause 
a rupture, rather than an inflammation. 

Its Symptoms are frequently quite obscure and of an uncertain 
character, so that it is often not recognized until post-mortem ex- 
amination brings it to light. AVe have a better chance of dis- 
covering its presence when it is produced by cardiac diseases, 
and there is also an enlargement of the spleen, which, however, 
never reaches more than double its normal size, and in many 
cases is so insignificant that it cannot be discovered by percus- 
sion. 

Pain in the region of the spleen originates not in the substance 
of the spleen itself, but in its enveloping membrane or in the 



ACUTE TUMOR. 629 

neighboring organs, and is, therefore, sometimes entirely want- 
ing. "When it does exist, it is of a dull character, and is increased 
by deep inspirations, different movements of the body, and per- 
cussion. A sharp pain denotes an inflammation of its peritoneal 
covering. A radiating pain into the left shoulder is likewise 
sometimes observed. 

Fever is usually entirely or partly dependent on the original 
disease; but when' suppuration has taken place, the character- 
istic rigors make, as a rule, their appearance. 

Peritonitis follows in case of rupture or perforation. On the 
whole a certain diagnosis can only be made when after trau- 
matic causes or in consequence of pyaemia, endocarditis, etc., local 
and general S3 T mptoms arise which can be referred to the spleen. 
And the diagnosis increases in probability if metastatic inflam- 
mation of other organs are developed at the same time, for in- 
stance in the kidneys with albuminuria and hsematuria. 

THERAPEUTIC HINTS.— Compare such remedies as are pointed 
out under the heads of those diseases which are either the causes 
or complications of splenitis, as endocarditis, valvular derange- 
ments of the heart, etc. 



Acute Tumor, or Hyperaemia of the Spleen. 

This consists of a more or less copious accumulation of blood 
within the gland, by which its volume may become enlarged to 
three or four times its normal size. The color of its tissues va- 
ries from red to brown or violet, and in case of a longer duration 
it changes to a dirty gray or slate color. 

This acute swelling of the spleen is an almost constant attend- 
ant upon typhus, intermittent, remittent, yellow and puerperal 
fevers; likewise upon cholera in its stages of reaction, and of a 
number of other complaints, such as pylephlebitis and cirrhosis, 
by which a stagnation in the portal circulation causes stagnation 
of blood in the spleen. We find it likewise attending anomalies 
of menstruation. It is therefore always of a secondary nature, 
and its symptoms must vary accordingly. Symptoms, which be- 
long exclusively to it, are — 

1. The conspicuous enlargement, which can easily be discov- 
ered by percussion and palpation. 

2. A dull pain in the region of the spleen, which is generally 



630 



increased by motion, pressure, deep breathing, and lying on the 
left side. 

3. A conspicuous ansemic appearance of the patient which, 
especially in intermittent fevers, sets in very quickly and keeps 
pace with the enlargement of the spleen. 

All other symptoms belong to the primary disease which 
causes it ; for therapeutic hints compare these diseases. 

Hypersemia of the spleen leaves with the primary disease; in 
some cases, however, it assumes a permanent form; and thus 
originates — 

Chronic Tumor, or Hypertrophy of the Spleen, 

The spleen sometimes attains a weight of 10, 15 to 20 lbs., filling 
almost the entire abdominal cavity. Its resistance is often like 
that of a board, and its substance appears dark brown-red. This 
is simple hypertrophy, consisting of an increase of granular sub- 
stances in the intertices, formed by the numerous fibrous bands 
of the splenic structure. In other forms it has, as a rule, the ap- 
pearance of waxy or colloid degeneration, and consists indeed of 
the same homogeneous colloid mass, which the colloid liver pre- 
sents, and then is called amyloid degeneration of the spleen. 

A peculiar variety of this affection is the so-called Sago-spleen, 
where the whole organ appears to be infiltrated with half-solid, 
transparent, round globules, which can be taken out, and very 
much resemble boiled sago. It seems that the development of 
this peculiar appearance depends upon the infiltration of the 
same colloid mass into the vesicles of Malpighi. 

The chronic tumor resulting from intermittent fevers is of a 
slate color. 

The Causes of this chronic enlargement of the spleen, when it 
is simple hypertrophy, are, all such disorders as cause a stagnation of 
blood within the venous circulation, to wit: heart and lung diseases, 
inflammation and obliteration of the portal veins, and cirrhosis 
of the liver; but when it consists of an amyloid degeneration, a 
number of diseases, which depend upon a morbid state of the blood — 
so-called dyscrasias — malaria, constitutional syphilis, mercurial 
cachexia, rhachitis, scrofulosis, Bright's disease, in a lesser de- 
gree, chlorosis, scurvy, and leukaemia. 

Symptoms. — Enlargement of the spleen, usually very great, and 
characterized by its roundish apex and the notch on its inner 



CANCER — ECHINOCOCCUS-CYSTS — RUPTURE. G31 

edge. All other symptoms belong more or less to the primary 
affection, and are therefore of no diagnostic value for the tumor 
itself. 

THERAPEUTIC HINTS must be looked for under the respective 
heads of causes ; however, the following remedies have a special 
relation to the spleen: Arnica, Asaf, Arsen., Borax, Bromium, 
Carb. veg., China, Dulcam., Ferrum, Ignat., Laches., Lauroc, 
Mercur., Mur. ac, Natr. carb., Natr. mur., Nux mosch., Platin., 
Plumbum, Ran. bulb., Rhus tox., Ruta, Stannum, Sulphur, Zinc. 

Spleen affections and obstinate diarrhoea: Anac, Asaf, Bryon., 
China, Dulcam., Ignat., Pulsat, Rhus tox., Sulph. ac. 

Cancer of the Spleen 

Is a very rare disease; is generally of the medullary or encepha- 
loid form, and sometimes attains a pretty large size; it is always 
connected with cancer in other organs, especially those of the 
abdomen. 

Its Diagnosis is easy, when the existence of cancer in other 
organs has been proved, and when the enlarged spleen shows on 
palpitation that characteristic cancer-unevenness. 

Echinococcus-cysts 

Are of very rare occurrence; they may exist in the spleen alone, 
and also in other organs at the same time. 

Its Diagnosis is difficult, being possible only under those fa- 
vorable circumstances in which the echinococcus-cyst is acessible 
to percussion and palpation, when it may be discovered as a 
roundish fluctuating tumor. 

Rupture of the Spleen 

May be caused by external injuries, violent concussions of the 
body, or by pathological changes of the gland itself, as in its 
rapid enlargement, especially in typhus, or during the chilly 
stage in intermittens. 

Symptoms. — A sudden very intense pain in the region of the 
spleen, spreading over the whole abdomen. And in consequence 
of the internal haemorrhage: paleness, collapse, cold extremities, 



G32 PANCEEAS. 

small pulse, vanishing of sight and hearing, syncope, distention 
of the abdomen, death. 

Its Diagnosis must be founded upon the sudden pain in the 
region of the spleen, and a knowledge of the previous ailments. 
A perforation of the stomach or of the intestine always causes 
tympanites by its air rushing into the peritoneal cavity, and peri- 
tonitis. The latter is also caused by ruptures of the liver, gall- 
ducts, and of the bladder; and besides, the pain which is hereby 
produced is not in the region of the spleen. A fatal termination 
usually follows, generally within twenty-four hours. 

DISEASES OF THE PANCREAS. 

The pancreas, the abdominal salivary gland, is situated behind 
the left lobe of the liver and the stomach, and discharges its secre- 
tion by a main duct into the duodenum in the vicinity of the 
opening of the ductus choledochus into the duodenum. Some- 
times the pancreatic and biliary ducts become united just before 
they enter the duodenum. 

Its secretion assists in the transformation of starch into dextrine 
and sugar, and in the digestion of albumen and of fat. It shares 
its saccharifying power with the saliva, perhaps also with the se- 
cretion from Brunner's glands, its peptonizing properties with the 
gastric juice and succus entericus, and its power of emulsifying 
neutral fats with the bile ; while its power of breaking up fat into 
fatty acids and glycerine is the only one which, as far as our knowl- 
edge of to-day goes, can be said to be peculiar to the pancreas. 

From this statement it may easily be seen why a diagnosis of 
diseased conditions of this gland is in most cases very difficult 
and in some altogether impossible. The following symptoms, 
however, may hint to affections of the pancreas without being 
pathognomonic: Emaciation of the whole body, beginning early 
and proceeding to an unusual degree; a flow of saliva-like fluid 
from the mouth, either as eructations or by frequent spitting; 
the presence of fat in the stools, sometimes in the urine floating 
upon it on cooling, like masses of butter; the presence of large 
quantities of undigested striped muscular fibres in the faecal dis- 
charges ; the presence of diabetes mellitus and also chronic jaun- 
dice. The pain in the epigastrium is shared by a great number 
of other disturbances, and even the results of palpation are in 
many cases negative on account of the deep position of the pan- 



PANCREATITIS — FATTY DISEASE AND CANCER OF PANCREAS. 633 

creas, and its being covered by the stomach and liver. Occasion- 
ally, however, palpation may lead to positive results, when per- 
formed with both hands by lateral pressure on the hypochon- 
driac regions, or in the knee-elbow position, when the altered 
pancreas may be discovered lying crosswise in the epigastric re- 
gion as a slightly moveable swelling, or as a round, firm, or fluc- 
tuating tumor, either smooth or nodular on its surface. Among 
these symptoms the most important are: fatty stools, mellituria, 
darting pains in the epigastrium, (cceliac neuralgia) together 
with a palpable tumor. 

.hist as little certainty exists as to the Causes of pancreatic dis- 
eases. In most cases, as far as we know, tbese affections are of a 
secondary nature, arising from diseases of neighboring organs. 
Fortunately pancreatic diseases are of great rarity. 

From among the special forms of morbid conditions of the 
pancreas as discovered principally on post-mortem examinations; 
the following may be mentioned : 

Pancreatitis, Inflammation of the Pancreas. 

Pathologically, it is characterized by swelling, redness, and 
softening of the areolar tissue, which surrounds the lobules of 
the gland; in a higher degree it alters the whole gland into a 
firm mass. It results either in resolution or suppuration, or leads 
to induration of the areolar tissue and obliteration of the 
glandular structure. It may be of an acute or chronic nature. 

Fatty Disease of the Pancreas 

Consists of a fatty degeneration of the gland-cells, analogous to 
fatty degeneration of other glandular organs, which destroys the 
secreting cells and causes atrophy of the entire organ, of which 
often nothing remains but a flaccid bandof connective tissue. 

Cancer of the Pancreas 

May be primary, originating in the gland, or secondary, spreading 
from neighboring organs to the gland. It causes no characteristic 
symptoms besides the general cancer-cachexia, and is, therefore, 
not distinguishable from other coexisting cancerous affections. 



634 



DISEASES OF THE KIDNEYS. 



The kidneys being the organs for secreting urine, any morbid 
state within them will, no doubt, cause changes in the product of 
their physiological function, although disease of the kidneys does 
not attend every abnormal state of the urine. Before we enter 
upon a consideration of the different renal disturbances, it will 
be expedient first to collect those symptoms which we may 
gain by- 
Examination of Urine. 

1. Its Reaction. Urine is naturally acid, which is easily tested 
by dipping into it blue litmus paper. This acidity varies much 
even in normal urine; it is increased before meals, decreased 
after meals; during digestion it is augmented by sulphuric, 
nitric, phosphoric, tartaric and oxalic acids when taken into the 
system. 

An alkaline reaction may take place sometimes during digestion 
without being a sign of disease; or it results from taking an 
excess of fixed alkalies, such as the salts of soda and potassa. In 
this case the red test-paper is colored blue and retains this blue 
color when exposed to heat. When it exists as a permanent 
condition it generally indicates nervous depression, resulting 
from exhaustion by mental anxiety, spermatorrhoea, etc. It is 
said to be produced temporarily by the juice of lemons and 
oranges. An alkaline urine may be caused also by a volatile 
alkali, such as carbonate of ammonia, in consequence of decom- 
position. This is generally recognizable by its odor, and the 
test-paper at once loses the blue color and receives back its origi- 
nal red tint when exposed to a gentle heat. This alkalinity of 
the urine denotes pathological disturbances, such as the presence 
of mucus or pus in the urine, in consequence of a disease of the 
mucous coat of the bladder, or in consequence of paraplegia, 
whereby the urine is too long retained in the bladder. 

2. Its General Appearance. A light, pale color is usually 
found in chlorotic and anaemic states of the system; in neuralgia; 
in hysteria (urina spastica); in diabetes mellitus, with much 
increased quantity and gravity; in chronic morbus Brightii; in 
leucaemia; in consequence of wear and tear of the nervous sys- 
tem, with a dash of white in it, containing phosphates. 



EXAMINATION OF URINE. 635 

A deep, dark color may be caused — 

1. By an increase of urea in the urine, which appears perfectly 
clear and transparent when freshly voided, and its foam when 
agitated is perfectly colorless. 

2. By an admixture of blood. In this case the urine is opaque. 
It is found: a, in haemorrhages from the kidneys; b, in hsernor- 
rhages from the bladder; and c, during menstruation or haemor- 
rhages from the womb, when it is of a mere accidental occurrence. 

3. By an admixture of bile. In this case the freshly voided urine 
is usually clear and transparent; its foam, when agitated, is 
intensely yellow; white paper and linen, when dipped into it, 
become yellow, even olive-green, and a drop of nitric acid, when 
permitted to fall on a thin layer of such urine, causes at once an 
interesting play of colors — commencing with green and blue, 
passing to violet, red, and finally to yellow or brown. It is found: 
a, in icterus; b, in the highest state of pyaemia; c, in the acute 
yellow atrophy of the liver; d, in some cases of pneumonia, 
especially on the right side. 

4. By different drugs, such as santonin, rhubarb, senna, turpen- 
tine, dyer's weed, beets, tar, kreosote, etc. 

A turbid appearance of the urine, when freshly voided, may re- 
sult — 

1. Fi*om an admixture of epithelium, thrust off by catarrhal 
processes of the mucous linings within the urinary organs. It is 
of a flocculent appearance and does not alter the specific gravity 
of the urine. 

2. From gonorrheal or leucorrhceal discharges, appearing in the 
otherwise transparent urine as whitish flakes. 

3. From cylindrical casts from out of the uriniferous tubuli, 
during the acute or subacute stages of Bright's disease. They 
soon settle to the bottom of the vessel, and form a light, downy 
sediment. 

4. From blood, as stated above, or chyle. 

5. From pus, which settles as an opaque, creamy or clayey 
mass; reaction, generally alkaline; it is desolved into a dense 
gelatinous mass, when agitated with an equal quantity of liquor 
of potassa, and smells foul and ammoniacal in consequence of 
decomposition. It is a sign of suppuration somewhere in the 
genito-urinary system, or a proof that an abscess has opened into 
and is being discharged through this channel. In chronic catarrh 
of the bladder pus forms a layer of grayish-white sediment. 



636 KIDNEYS. 

6. From earthy salts, generally, however, only after cooling. 
a. Uric acid settles in little red granules of a crystalline character, 
visible to the naked eye, while urates constitute more of a pinkish 
or yellowish sediment; the urine appears dark, shows an acid 
reaction, and becomes transparent by the application of heat. 
When a few drops of nitric acid are added, and the mixture is 
slowly evaporated nearly to dryness over a lamp, the addition of 
a drop of ammonia instantly produces a rich purple (Dr. Prout's 
Purpurate of Ammonia), b. Phosphates — a combination of phos- 
phoric acid with soda, lime or magnesia. Such urine always 
yields an alkaline reaction, is usually of a whitish milky color 
with whitisli sediment of an offensive odor, and clears up at once 
by the addition of a few drops of acetic acid. 

3 a . The urine contains one or the other of its normal 

CONSTITUENTS IN EXCESS OR IN DECREASED QUANTITY (Compare 

CI. Mitchell's " Clinical Significance of the Urine and its Normal 
Constituents)." 

Urea, C H 4 N 2 0, may be suspected in excess if the urine is of 
a deep yellow color, of a strong urinous smell, and of high specific 
gravity, and may be chemically demonstrated as follows : " Pour 
an equal bulk of nitric acid upon the given specimen, which has 
not been boiled, and which ought to be part of the entire quantity 
of urine passed in twenty-four hours." This will produce the 
formation of crystals of nitrate of urea. 

Urea is increased in all fevers (except yellow fever), in acute 
febrile states with emaciation, in inflammations generally, also 
those of thoracic viscera often, in nervous diseases, such as epi- 
lepsy, chorea, progressive muscular atrophy, in pyaemia, diabetes, 
atrophy from dyspepsia (in children), and diffuse bronchial 
catarrh (without fever). 

The amount of urea is diminished in paralysis, cholera, yellow 
fever, albuminuria, acute yellow atrophy of liver, long-continued 
organic diseases, chlorosis, ovarian tumors and uterine cancer. 

Chlorides of sodium (Na CI) and Potassium (K CI) are soluble, 
hence do not appear as a deposit in the urine. Sodium chloride 
is largely in excess of the two. If a sample of urine is evaporated 
and the residue ' placed under the microscope, there appear 
octahedral crystals which can be distinguished from oxalate of 
calcium by their solubility in water. If urea be present instead 
of octahedral crystals the sodium chloride may assume the form 
of stars or daggers. Or after filtering a sample of urine, then 



EXAMINATION OF URINE. 637 

boiling and acidulating it with two to three drops of nitric acid, 
in order to remove the albumen, and adding to this solution, free 
from albumen, a solution of silver nitrate (strength one to ten), a 
white precipitate, silver chloride, which is insoluble in nitric acid 
but soluble in ammonia, indicates the presence of the chlorides. 

The chlorides are increased in intermittents only during the 
chill and fever, and in progressive muscular atrophy; they are 
decreased in acute diseases, including especially inflammations with 
exudations, fevers, cholera, diabetes insipidus (not invariably) 
and dyspepsia (also not invariably). 

The Phosphates, as sodium bi-phosphates or sodium phosphate, and 
potassium, calcium and magnesium phosphate. The alkaline phos- 
phates (sodium and potassium) are soluble, and therefore not 
found as a deposit. The earthy phosphates are insoluble in alka- 
line liquids, and hence appear as a deposit when the urine is 
alkaline; the deposit is whitish in color, the urine is of alkaline 
reaction and of a fetid odor. If some of this whitish deposit is 
diluted with distilled water, then acidulated with a few drops of 
nitric acid, and to it is added ammonium molybdate and heat 
applied, a yellow precipitate indicates the presence of earthy 
phosphates. The alkaline phosphates may be detected by the 
addition of a little ammonium hydrate (ammonia) to the urine 
and heat applied, which precipitates the earthy phosphates. After 
these are filtered off, and we add to the filtrate ammonium car- 
bonate and magnesium sulphate, we obtain a white flocculent 
precipitate which consists of alkaline phosphates. 

The total amount of phosphates may be increased in phrenitis, 
meningitis, mania (acute paroxysms), paralysis following injury 
to the head, paralysis in general, especially if spinal cord be 
affected, chorea, apoplexy and epilepsy (after the attack), acute 
febrile diseases, Bright's diseases and cholera. 

The calcium phosphate may be especially increased in rhachitis, 
mollifies ossium, extensive burns, nervous exhaustion from severe 
study and loss of sleep, diabetes (when thirst is satisfied by drink- 
ing water), tertiary syphilis, cerebral and spinal tumors, osseous 
tumors, cancer, caries, meningitis. 

The magnesium 'phosphate may be especially- increased in men- 
ingitis, and in progressive muscular paralysis, while the ammonio- 
magnesium phosphate, the so-called "triple phosphate," is found 
largely present in the urine in calculus, paralysis of bladder, re- 
tention of urine, diseases of the spinal cord. Urine containing 



638 KIDNEYS. 

this "triple phosphate" is apt, when passed, to be alkaline, put- 
rid, whitish in color. 

The total amount of phosphates may be decreased in functional 
disturbances of kidneys, as in Bright's disease, in diseases of the 
digestive organs (food not thoroughly absorbed), in intermittent 
fever during the interval, in chronic diseases of the brain, in mania 
(exhaustion stage), in acute dementia (least amount when mind 
most feeble), in pneumonia (when grave), in gout, arthritis de- 
formans, delirium tremens. 

We find magnesium phosphate lessened in amount in the urine 
of typhus fever and of grave fevers generally. 

The Sulphates of potassium and sodium are soluble in water, hence 
do not appear as a deposit. They are detected by acidulating a 
small quantity of urine by a few drops of hydrochloric acid, and 
then adding barium chloride, which causes a precipitate of sul- 
phate of barium, insoluble in nitric acid. Vogel finds but little 
satisfaction in investigating the clinical import of the sulphates 
in disease. 

The Urates of sodium, potassium and ammonium are soluble; 
acid urine, however, on cooling may contain them as a deposit in 
which the urate of sodium is generally the most abundant of any. 
If such deposit disappears again on heating, it consists of urates. 
If a heavy, yellow or pink deposit occurs in acid urine on cool- 
ing, place a few grains or crystals of it on a porcelain disk, add a 
drop of nitric acid, heat gently, add a drop of ammonium hydrate ; 
magnificent red color indicates presence of urates or uric acid. 
(Uric acid is crystalline under the microscope, but urates are not.) 

The amount of urates may be increased in ordinary fevers, pul- 
monary emphysema, capillary bronchitis, diphtheria, dysentery, 
influenza, intermittent (febrile stage), nephritis, scarlet fever (at 
eruption), and chiefly free uric acid deposit, as in tetanus, acute poly- 
arthritic rheumatism, chronic affections of heart, liver and spleen, 
atrophy from dyspepsia in children, incipience of gravel or of 
calculus. 

The amount of urates may be diminished in yellow fever, remit- 
tent fevers, diabetes, albuminuria, cholera, chlorosis, anaemia, 
hysteria, gout (before the paroxysms), progressive muscular 
atrophy. 

3 b . The urine contains other than normal constituents, 
of which the most important are : 

1. Grape-sugar. — This substance increases the specific gravity 



EXAMINATION OF URINE. G39 

of the urine up to 1040 and higher; in one ease it was changed 
as high as 1074. To detect it, Trommer's test with caustic pot- 
ash and sulphate of copper is still considered the best. "If a 
solution of sugar is treated with a little caustic potash and a few 
drops of a solution of sulphate of copper, either no precipitate 
occurs, or that which takes place dissolves again to a beautiful 
blue fluid. If this mixture be heated the fluid is first colored 
orange-yellow, soon becomes cloudy, and finally a beautiful red 
precipitate of cuprous oxide separates." (Neubauer.) "This, 
then, is what happens when sugar is actually present; when 
sugar is absent, the addition of caustic potash solution causes, 
perhaps, a cloudiness to appear; then, when the sulphate of cop- 
per is added, the beautiful blue color may or may not be pres- 
ent, according to the quantity of copper sulphate added, but 
when heat is applied, there results either (1), a liquid, generally of 
a color slightly darker than normal urine, containing dirty, 
white flocks of phosphates, or else (2), a bluish liquid containing 
these same flocks of phosphates; when there appears no orange- 
yellow, which soon becomes cloudy, ending in a beautiful red precipi- 
tate, there is no sugar." (Clifford Mitchell.) 

Or, "if a solution of grape-sugar be warmed with caustic potash, 
it becomes a beautiful brown-red color; if nitric acid is then 
added, a piercing, sweetish odor is evolved, which reminds one 
of caramel or of formic acid." (Neubauer.) " In the case of urine 
containing sugar then, caustic potash solution added, heat ap- 
plied, and further nitric acid added, converts the liquid into a 
substance strongly resembling molasses." (Clifford Mitchell.) 

2. Albumen. — In general its presence may be looked for if the 
specific gravity of the urine is persistently below 1015, and 'it 
may be detected by heating the urine up to a boiling point which 
coagulates sero-albumen, if only the urine itself be acid and has 
been rendered clear by previous filtration. Neutral or alkaline 
urine must be rendered acid before the operation by addition of 
nitric acid. Or to avoid all possible chance of confounding albu- 
men w r ith phosphates or urates, fill a test-tube one-third full of a 
solution of picric acid, and pour one or two drops of the urine, 
to be examined, into it. If it contain albumen, a cloudiness will 
at once be seen in the previously clear fluid, which, on the ap- 
plication of heat, balls into a compact mass and rises to the 
surface. 

3. Chyle. — " In tropical regions, especially in the Brazils and in 



640 KIDNEYS. 

the Southern States of North America, the urine presents, on ex- 
ceptional occasions, at rare and long intervals of time, an aspect 
that might easily be mistaken for milk. This appearance de- 
pends upon a quantity of fatty matters, stirred up into a fine 
emulsion, and mixed with the secretion from the kidneys; in 
fact, the fat is sometimes so abundant as to form a thick cream 
upon the surface of the fluid. Looked at under the microscope 
it does not present the form of fat-cells or fat-drops, such as we 
see in ordinary milk, but appears as a finely granular opacity 
that pervades the fluid, and is capable of being entirely sepa- 
rated from the urine by treating this with ether. We find in- 
variably associated with it a considerable quantity of albumen, 
also red and white blood-cells, all characteristic, formed ele- 
ments of chyle. For this reason the affection thus manifesting 
itself has been termed chylwria. The exact nature of it is still 
unknown." (Bartels.) 

4. Blood. — Its presence can usually be recognized by its charac- 
teristic color which may, however, vary from that of pale, raw 
meat up to brown-black, in accordance with the quantity present. 
Bloody urine is oftener sooty or dark colored than bright red, 
and the liquid is more usually cloudy than clear. Small quanti- 
ties may be recognized by allowing the urine to stand in a funnel- 
shaped glass when the blood-corpuscles will sink to the bottom. 
By means of the microscope the blood-cells can be distinguished 
in the sediment, Bloody urine is invariably albuminous. 

5. Urinary casts or cylinders, when found in the urine, always 
denote an abnormal condition of the kidneys ; they are, as a gen- 
eral rule, associated with the excretion of albumen in the kid- 
neys. There are different kinds of cylindrical formations. 

a. Epithelial casts consist of simple pipes formed of the epithelia 
of renal tubes which are shed in their natural continuity in the 
course of acute inflammation. They are not often seen. 

h. Blood casts consist of coagulated fibrine with a large amount 
of entangled red blood-corpuscles, and are derived from the renal 
tubules in luematuria, 

c. Hyaline casts consist of a perfectly homogenous, transparent 
and colorless mass; their outlines are only with difficulty rendered 
apparent in the fluid surrounding them, but may be made visi- 
ble by adding a solution of iodine or iodide of potassium, which 
colors them yellow, or a weak solution of carmine, which stains 
them red. 



EXAMINATION OF URINE. 641 

d. Dark granular casts consist of granular masses and are less 
transparent than the hyaline casts. 

e. Waxy casts consist of a homogeneous mass which exhibits 
under the microscope a peculiar glistening aspect and they often 
have a distinct yellow staining. 

/. Cylindriform casts consist of a homogeneous, colorless and 
very pale mass ; they present under the microscope more the ap- 
pearance of strips of ribbon, than of real cylinders, and their 
edges run parallel to each other, their ends are either frayed out 
or tattered, or pointed at one edge, or folded or twisted up in a 
spiral. The presence of such casts proves the presence of albu- 
minuria, but does not point out the nature of the cause in pro- 
ducing albuminuria. However the following remarks may as- 
sist in the diagnosis of kidney-diseases. 

A great number of pale or dark granular casts comes from an in- 
flamed kidney. In the acute form the pale casts with an abund- 
ance of red or white blood-corpuscles, — in the chronic form the 
dark granular casts prevail. 

The waxy casts always point to chronic and deep-seated renal 
affection and are never present in recent cases of nephritis, nor 
in transitory albuminuria. With them are generally found at 
the same time the other forms in the sediment. 

The dark granular casts always indicate a notable impairment 
of the nutrition of the organ, such as chronic nephritis and amy- 
loid disease of the kidneys. 

Narrow hyaline colorless casts can appear in any albuminous 
urine, and they are always found in company with the dark 
granular and waxy cylinders. 

The Sediments of the urine may be distinguished in the following 
manner : 

1. A light, flocculent, cloudy deposit is commonly mucus, entan- 
gling epithelial cells or spermatozoes. 

2. A yellow, orange, or pinkish deposit, dissolving by the applica- 
tion of heat (urine acid) is almost always due to urates. In very 
rare cases a dark, citron-yellow color is caused by the great abun- 
dance of renal casts. 

3. A dense, abundant, white deposit, dissolving by the addition 
of acetic acid (urine alkaline) consists of phosphates. 

4. A granular, or crystalline deposit of reddish color and small in 
quantity is uric acid. 

5. A dark, sooty and dingy-red deposit is blood. 
41 



642 KIDNEYS. 

The Quantity of urine varies, even in health, considerably. It is 
increased, however, in diabetes, chronic diuresis, hysteria, and by 
drinking large quantities of water or other fluids. Decrease : 
Fevers of all kinds, deep functional disturbances, profuse excre- 
tions other ways, such as sweat or diarrhoea ; in consequence of 
heart diseases, liver diseases, dropsy. Its secretion ceases altogether 
in cholera, and in typhus at times. 

Its Specific gravity is also greatly variable. According to Clif- 
ford Mitchell's observations upon fifty anal}*ses of urine, an in- 
crease in specific gravity simply means an increase of solids. In 
most febrile conditions, urea, phosphates, sulphates and urates 
are increased in amount, and with them the specific gravity of 
the urine. The presence of earthy phosphates may raise it to 
1037. When the specific gravity is 1040 or upwards, we are very 
sure of finding sugar in the urine. "When the specific gravity 
ranges from 1015 to 1030, we need not expect, as a rule, to find 
either sugar or albumen, although we may find blood or pus. 
When the specific gravity is persistently below 1015, we are war- 
ranted in looking for albumen. The lowest specific gravity has 
been observed in diabetes insipidus and renal cirrhosis, varying 
between 1004 and 1010, and sinking at times to 1002, or even to 
1001. 

Diabetes, Mellituria, Glycosuria. 

This disease is characterized by the presence of sugar in the 
urine, and although not strictly a kidney disease, it may as well 
be treated of here as under any other heading, especially as the 
modes of its development are still under discussion. The most 
probable modes, as applying to the majority of cases of diabetes, 
Senator states in the following language: (1) "An abnormally 
heightened saccharinity of the chyle, or of the blood in the portal 
vein, or of the two together, in consequence of an impeded con- 
version of the sugar present in the intestine into lactic acid, or 
in consequence of accelerated absorption of the sugar: c2) an 
unnatural acceleration of the portal circulation, whereby, on the 
one hand, more sugar reaches the liver, — a part of which, without 
being changed into glycogen, passes on into the circulation: and. 
on the other hand, the glycogen formed from sugar or other 
materials passes into sugar more rapidly and in greater quantity 
and is washed away." 



DIABETES, MELLILURIA, GLYCOSURIA. 043 

Under the first proposition is taken into account that the sac- 
charinity of the blood may originate in the intestine by an ab- 
normally large ingestion of starch or sugar with the food, or by 
an abnormally heightened transit of sugar from the intestine into 
the lacteals even without increased ingestion, all of which would 
explain those symptoms so common in diabetics which point to 
an implication of the gastro-intestinal canal, and which exist 
often even before the outbreak of the disease and during its 
development. Under the second proposition is taken into con- 
sideration the theory of Claude Bernard and others that the 
saccharinity of the urine may originate a, in some disturbance 
of the nervous system (Bernard's puncturing the fourth ventricle 
on the floor of the fossa rhomboidea, immediately above the 
point of origin of the vagi nerves, or Schiff 's section of the optic 
thalami and the great crura cerebri, or the destruction of the 
pons Varolii and the middle and posterior crura cerebelli, or the 
complete division of the spinal cord at the level of the second 
dorsal vertebra, or in its lumbar portion, or Pavi's section of the 
medulla oblongata etc.), causing either a dilatation of the blood- 
vessels by paralyzing the vasomotor nerves, or a specific irri- 
tation of the nerves which govern the formation of sugar (both 
views being hypothetical), or b, from the action of the liver by 
which sugar, glycerine, gelatin, and probably albuminates are 
converted in its cells into glycogen, and that the latter is 
transformed into grape-sugar by reaction with the blood which 
bathes the cells, that it then passes into the general circulation, 
and if its quantity exceeds a certain limit, is finally excreted by 
the kidneys. These modes of development which we may desig- 
nate as gastro-enterogenic, the neurogenic and the hepatogenic, 
do not exclude each other, but may for the most part or altogether 
occur simultaneously, or the one may proceed and the others 
may join in. 

Post-mortems have shown various morbid changes in the cor- 
responding and other organs, although these changes are by no 
means constant. In the brain tumors, extravasations of blood, 
softenings and on microscopic examination a wasting of the gray 
substance, degeneration and striking pigmentation of the gan- 
glion cells and fatty degeneration of the vessels have been found. 
The sympathetic nerves in the abdomen were found thickened and 
also the vagus. The lungs frequently showed signs of chronic 
inflammations, tuberculosis and pleuritic exudations. The stomach 



644 KIDNEYS. 

and the intestinal canal frequently bore signs of chronic catarrh, 
hyperemia, thickening, tumefaction of their mucous membrane, 
slaty pigmentation and hsemorrhagic erosions. The liver has 
frequently been found hypersemic, uniformly enlarged and hyper- 
trophied. The pancreas has frequently been found atrophied, or, 
in addition, degenerated; and the kidneys appeared, as a rule, 
abnormally enlarged, heavy, firm and containing an abundance 
of blood, but without more profound textural changes. The pelvis 
of the kidneys and the ureters Avere frequently found in a state of 
catarrhal inflammation ; and in some cases of young persons the 
testes were found atrophied. Diabetes is not of frequent occurrence, 
seems to be to a certain extent hereditary, is often connected with 
diseases of the nervous system, particularly epilepsy and mental 
affections, occurs at every period of life, but far more rarely in 
childhood than in middle age; after the age of sixty or sixty-five 
it scarcely ever develops; men are much oftener attacked than 
women; also obesity seems to predispose to the disease. As 
Exciting Causes the following have been mentioned : meehan iced 
■injuries, especially concussions of the whole body or of the brain 
and spinal cord in particular; diseases of the nerve-centres, such as 
inflammations, degenerations, softenings and tumors of the brain ; 
violent mentcd emotions, such as fright, anxiety, anger, grief, 
solicitude, care, immoderate mental strain: errorsin did; exposure 
to cold and moisture; severe bodily exertions; .sexual excesses; and 
not unfrequently diabetes has been observed to make its first 
appearance during the convalescence from febrile diseases of 
greater or less gravity, especially after intermittent fever. l>esides 
these exciting causes the following substances, which, whether 
introduced into the general blood-current or into the portal cir- 
culation, have been found to cause mellituria with more or less 
certainty: Curare, cantharis, carbonic oxide, chloride of carbon, 
nitrite of amyl, nitro-benzole, phosphoric acid, turpentine, corro- 
sive sublimate, nitrate of oxide of uranium, morphia and strych- 
nia; injections into the veins of solutions of common salt, of car- 
bonate, acetate, phosphate, hyposulphite, valarianate and succinate 
of soda; of ether, alcohol or ammonia into the portal vein and of 
large quantities of lactic acid into the stomach. 

The Symptoms of diabetes set in at times suddenly, but in gen- 
eral very gradually, with an increase of the urinary excretion 
and of thirst. Its initial stage, if there be any, is characterized 
usually by loss of appetite, nausea, vomiting, pyrosis, eructations, 



DIABETES, MELLITURIA, GLYCOSURIA. 645 

irregular action of the bowels, headache, sleeplessness, and even 
mental aberrations. But perhaps much oftener the disease in- 
vades the system unnoticed, until the frequent desire to pass 
water, the constant dryness of the mouth, the increased debility, 
or an impairment of sight, force the attention of the patient 
upon it. 

In the proportion as the urine increases in quantity, its color 
becomes lighter, verging on greenish or looking almost entirely 
colorless and as clear as water; it is free from sediments. Its 
odor is often peculiarly aromatic, likened by the older physicians 
to that of hay, being derived, according to recent observations, 
from acetone and alcohol. Its reaction is not only acid while 
fresh but remains so much longer than healthy urine generally 
does. Its specific gravity very commonly rises to 1035 or 1040, 
and even to 1060 or 1074. Its quantity is greatly increased, and 
generally in proportion to the severity of the disease, amounting 
to six and eight litres daily. 

Next to the altered state of the urine there is increased thirst 
and hunger. The thirst particularly is in direct ratio to the ex- 
cretion of sugar. Farinaceous and saccharine food not only in- 
creases the sugar but also the thirst. The appetite is usually 
largely increased so that even unusually hearty food, especially 
the saccharine and starchy seems able to appease the hunger 
only for a short time. Still at times temporary disturbances 
with signs of gastric and intestinal catarrh set in, impairing the 
effect of an exclusively animal diet. 

The patients breath commonly emits a peculiar, apple-like 
odor, and chronic pneumonia leading to phthisis is of frequent 
occurrence, although in patients under favorable surroundings 
and good dietetic conditions it is developed exceedingly slow. 

The nervous system shows many disturbances, of which are to 
be mentioned : pronounced mental affections and aberrations, 
varying moods, irritability, sadness, melancholy, disinclination 
to bodily or mental exertion, headaches, sensations in the limbs 
as being asleep, formication, neuralgic pains, partial anaesthesia, 
muscular twitchings, and a decrease of the sexual instinct. The 
most common form of disturbance of vision is occasioned by the 
formation of cataract, less often by partial paralysis of accommo- 
dation, by amblyopia, gradually passing into progressive atrophy 
of the optic nerve, by hsemorrhagic and inflammatory affections 
of the retina. The hearing is rarely impaired ; oftener there is a 



646 KIDNEYS. 

nervous roaring in the ears. Blunting of the senses of smell and 
taste have also been observed. 

The skin is usually dry, and hectic sweats set in only as con- 
comitants of pulmonary phthisis. As a general thing, there is a 
great tendency to the formation of furuncles and carbuncles, also 
at times to gangrene of the skin, or of the toes or even a whole 
limb. (Edema, especially of the lower limbs, is the result of ad- 
vanced cachexia, exceptionally only of a complicating severe 
affection of the kidneys. 

Fever, in the absence of inflammatory complications, does not 
occur; on the contrary, the temperature is very commonly some- 
what below the normal, between 95.9° and 97.7° F., and even 
temperatures as low as 93.2° F. have been observed. 

The duration of the disease is, in rare cases, extraordinarily 
brief, lasting only some weeks or months. Such cases occur, 
without exception, only in children and young persons. Usually 
the disease lasts for years. No doubt a number of cases have 
been cured by different modes of treatment, or have at least been 
greatly relieved. 

THERAPEUTIC HINTS.— The diet, as recommended on physio- 
logical grounds, should be selected from the following articles: 
the flesh of mammalia and birds, fishes, oysters, clams, crabs, 
lobsters, etc., cheese, eggs ; salads, cucumbers, water-cresses, spin- 
ach, asparagus, cabbage, oyster-plant, radishes, beets, truffles; 
butter, lard (oil to a certain extent); fruits, especially peaches, 
cherries, strawberries and currants ; nuts. Bread, although con- 
taining a great deal of starch, can never be entirely omitted. 
Milk is allowable, but exclusive use of skimmed milk can only 
be exceptionally borne : some have seen nothing but detriment 
from it. Among the spirituous drinks the red wines are allow- 
able; sugared brandies, sweet wines, champagne and cider should 
be entirely avoided. 

Dr. During, in Hamburg, treats his patients in the following 
manner : At six o'clock, a.m.. the patient is wrapped in wet sheets 
and being well covered with blankets, he remains lying by open 
windows for one to two hours. After having been rubbed until 
dry, he gets his breakfast consisting of milk, with the addition of 
one tablespoonful of lime-water to one cupful of milk, and stale 
bread. This is followed by one to two hours walk in the open 
air. At about 10J to 11 a.m., the patient receives another piece 



DIABETES, MELLITURIA, GLYCOSURIA. G47 

of stale bread with some meat, or a soft-boiled egg and half a 
glass of good red wine mixed with water. Should this not agree 
he receives instead a plateful of rice or farina soup, with or with- 
out milk, the milk being always mixed with lime-water. This 
lunch is again followed by a walk in the open air of one-half to 
one hour's duration. Before dinner the patient takes a nap or 
rest for one hour. For dinner at two o'clock, p.m., he receives 
rice and roasted meat, or ham or smoked meat, or venison — but 
without spices or vinegar. In some cases dry peas or white 
beans, well boiled, are allowed. Dried apples, prunes or cherries, 
also asparagus, green beans, cauliflower and carrots boiled in 
water, not in broth and without butter or fat, constitute other 
articles for dinner. A moderate allowance of green apples or 
cherries is given only in exceptional cases. The dinner is fol- 
lowed again by a walk of one to two hour's duration. Supper 
takes place at seven o'clock, p.m., consisting of rice, grits, pearl- 
barley or water soup, with salt but without butter, and is followed 
by another half-hour's walk. At nine or latest at ten o'clock the 
patient retires to bed. 

This mode of treatment of Dr. During has produced undoubt- 
edly the most gratifying results in diabetic patients, and it clearly 
demonstrates that the exclusive "meat diet," recommended on 
"physiological grounds," is very much like the treatment of 
chlorotics with "iron prepai-ations" on physiological grounds, 
both of which lack merely in this important point, that they do 
not cure, because the human body is not a chemical laboratory, 
but a living organism. 

Prout's experience, probably the largest of any observer, and 
drawn principally from the well-to-do class, is to this effect: 
" Within the last thirty years I have seen more or less of nearly 
seven hundred instances of diabetes, and of this great number, as 
far as minor and concomitant symptoms have been concerned, no 
two cases have been exactly alike, or have been benefited by ex- 
actly the same treatment, so greatly diversified is this apparently 
simple form of disease." 

Therefore a specific remedy for diabetes does not even exist, 
and a homoeopathist will only feel gratified to find the special 
hints extended over a large number of remedies. 

Arg. met, Hahnemann says, some forms of diabetes may be 
cured by silver if the other symptoms correspond to the symp- 
toms of this remedy. Ruckert mentions a case which he cured 



648 KIDNEYS. 

by Argent., but which died of phthisis afterwards. He mentions : 
urine turbid, of a sweetish taste and profuse, especially at night; 
scrotum and feet cedematously swollen; anxiety and pressure in 
the pit of the stomach and want of breath. 

Ars. alb., in a drunkard, horrible thirst, emaciation and exhaus- 
tion, with odd hallucinations. Eruptions on the skin and ten- 
dency to boils; vulva and vagina become red and swollen, with 
pruritus; teeth loose; skin dry and mealy; cachexia; kidneys 
affected; oedema of legs. 

Asclep. viii., five cases reported as essentially improved by it: 
arthritis; bleeding of gums; impotence. 

Berber., sticky saliva, like cotton; pale-yellow urine with a 
gelatinous sediment; pulse slow and weak; paralyzed, bruised 
sensation in the back ; intense coldness of knees. 

Canthar., one case improved as reported by Goullon, with fre- 
quent and profuse urination, rapid loss of strength and great 
dejection of spirits. (30th potency in water every two hours i. 

Carb. ac, one case with short, dry, backing cough. (Haesseler — 
y^j- and later ^ dilution.) Goullon thinks it one of the most 
important remedies. 

Chelid., enlargement of liver and icteric color of face; bloated 
face ; great weakness, emaciation. (In ten-drop doses of tincture.) 

Coloc, urine when voided is white and turbid, when getting cold 
it coagulates and becomes a milk-white, jelly-like mass, which, 
when poured out, glides in a compact cake out of the vessel. 
(Chyluria?) 

Cuprum, recommended, but no cures. 

Curare, recommended for acute cases. 

Digit, recommended, but no cures. 

Helon. dioic, several cases reported as cured. Dull, gloomy and 
irritable; melancholy; complete impotence: pain and lame feel- 
ing in back; numbness in the feet, going off by motion. 

Iodium, appears to have all the peculiar symptoms of diabetes: 
unappeasable hunger with steadily increasing emaciation; violent 
thirst; hepatic and gastric troubles; increased secretion of urine: 
pulmonary inflammatory symptoms; tendency to eruptions and 
furuncles. I cannot find that it has ever been given. 

Kali brom., tongue red and tender; gums spongy and bleeding: 
liver tumid and tender; bowels constipated, urine loaded with 
sugar. 

Kali hydr., in complication with pneumonic troubles, recom- 
mended by Kafka. 



DIABETES, MELLITURIA, GLYCOSURIA. 649 

Kreosot., three cures and one improvement. Heaviness all over 
with drowsiness; dimsightedness ; impotence; bruised sensation 
of chest and all along the back ; physical exhaustion. 

Laches., recommended. 

Lact. ac, recommended by Cantani and used with considerable 
success by others. Tongue dry, parched, sticky ; feeling of empti- 
ness and sinking at stomach; bowels costive, faeces hard and 
black ; debility ; aversion to move; chilliness, especially extremi- 
ties. (First dil. in five-drop doses, morning and evening. J. E. 
Wittemore.) 

Lycop., excessive micturition in gushes; fluor albus drops out 
in clots ; drawing pains in right groin on rising from seat, better 
after motion. (Lippe.) Sexual desire and power gone ; pulmon- 
ary phthisis, with hectic fever; gouty lithsemia. 

Lye. virg., from central and sympathetic nervous system ; bron- 
chial irritation, with sighing respiration ; cardiac depression. 

Magn. usta, relieved in one case. 

Magn. sulph., cured one case. 

Mineral waters, Karlsbad, Gastein, Wildungen, in Germany; 
Vichy, in France ; Bethesda and Gettysburg, in United States. 

Moschus, one case with impotence cured. 

Natr. mur., despondency; excessive dryness of mouth; no 
sweat; skin cool; sallow complexion; constipation, with sensa- 
tion of contraction of the anus. 

Natr. sulph., one case cured by Aegidi, with 3d dil., five drops 
four times a day. Hydrogenoid constitution. 

Nux vom., spinal lesions exciting cause; irritable temper; odd 
sensations in the limbs, fidgets ; numbness and paretic condition 
of the lower extremities; stomach and liver complaints. Good 
livers, sedentary habits, previous abuse of liquor and drugs. 

Opium and its derivatives. Dulness, sadness, weak memory ; 
after mental shocks, or injuries. 

Phosphor., gouty diathesis; disease of the brain; cerebral symp- 
toms; cheesy degeneration of the lungs. 

Phosph. ac, urine like milk, mixed with jelly-like, bloody mu- 
cus, or clear like water ; pain in the back and region of the kid- 
neys; sleeplessness; excessive emaciation; great prostration. 
After loss of animal fluids; after grief, anguish, sorrow and care. 
" When the starting point lies in the nervous system." (Prout.) 

Plumbum, lowness of spirits, anguish and melancholy; diminu- 
tion of sight; dryness of mouth; dry, cracked tongue; suppura- 



650 KIDNEYS. 

tion of lungs; hectic fever; impotence; dryness and brittleness 
of skin; gangrene. Dr. Hering considered it one of the most 
important remedies in this form of disease. 

Ratan., case much improved. 

Sec. corn., is similar to Plumbum; furuncles, petechia?, gangrene. 

Silic, successful in several cases. 

Sulphur, cured one case. 

Sulph. ac, a case much improved. 

Tarant, profound grief and anxiety; loss of memory and dim- 
ness of sight; violent pain in lumbar region and paralysis of the 
lower extremities; miliary eruptions and furuncles. 

Tereb., caused sugar in the urine. 

Uran. mur. and nitr., many cases have been cured or much im- 
proved by either of these preparations, usually administered in 
the 1st or 2d trituration or dilution, several times a day for 
weeks. It is indicated, according to Prout, when the disease 
originates in assimilating derangements. Tongue reddish at 
edges; dyspepsia. 

Dr. Francis Black recommends: 

For debility: Phosphor., Phosph. ac, Arsen., China, Moschus, 
Camphora, Pier. ac. 

For liver symptoms: Digit., Kali bicbr., Merc, sol, Iod. m., 
Hepar, Sulphur, when there is diminished bile in the feces. 

Euvonvmin, Iridin, Leptand., Podoph., Merc, corr., Iod. m., 
Nitr. ac, when there is increased flow of bile. 

Nux vom., Lycop., Nitr. ac, Merc, corr., Iod. m., Chelid., when 
there is no marked disturbance in tbe secretion of bile, but head- 
ache, frontal or occipital, vertigo, languor, weariness in limbs, 
uneasiness about the liver or scapular regions, furred tongue, 
often indented at sides, loss of appetite, flatulence, great depres- 
sion and irritability of temper, constipation, with dark or pale 
motions, or normal color, sometimes alternating with diarrhoea, 
intermitting pulse and palpitation of the heart. 

Amm. mur., when there is lithsemia and catarrh of the fauces 
extending to stomach. 

Colchic, Nux vom., Kali iod., when there is gouty disposition. 

Kali iod., in syphilitic taint. 

For urinary and sexual symptoms: Arsen., Aeon., Camphora, 
Tereb., Canthar., Kali bichr., when there is rapid decrease in the 
secretion of urine with strangury, or excessive itching and sense 
of fulness in the vagina, 



DIABETES INSIPIDUS. 651 

For pulmonary affections: Phosphor., Arsen., Ioclium, Hepar. 

For nervous symptoms: Aeon., Atropia, Phosphor., Argent., 
Aurum, Kali hydr., if cerebral. 

Nux vom., Veratr., Silic., Phosphor., if spinal, and Aeon., 
Atropia, Opium, Nitrite of Amyl, if tendency to apoplexy. 

For furuncles and carbuncles: Arnica, Phosphor., Arsen., Silic, 
Hepar. 

This list may be enlarged from the above given special hints. 

Diabetes Insipidus, 

Also going under the name of polyuria, hyperuresis, urinse pro- 
fluxio, polydipsia, " is applied to every chronic, morbidly increased 
excretion of urine, free from sugar, which is caused by no pro- 
found structural changes of the kidney, and which constitutes 
either the sole or at least the most prominent and primary morbid 
phenomenon." (Senator.) 

The term diabetes insipidus excludes any temporary increase 
of urine which is caused by excessive ingestion of fluids, by the 
use of diuretics, by interference with the loss of water through 
the lungs and skin, by the absorption of watery exudations, 
during convalescence from febrile diseases, or during hysteria or 
other diseases of the nervous system. 

The amount of urine evacuated in twenty-four hours varies 
greatly in different cases and in the same case at different times; 
it may vary from a point only slightly above the physiological 
maximum to ten or twenty times that amount. Its color is pale 
and clear, resembling water with a slight greenish tint; a peculiar 
odor of the urine is scarcely to be perceived, and its reaction is 
very faintly acid; it becomes neutral and alkaline more rapidly 
than usual, and turbid from earthy r phosphates and bacteria. 

Its specific gravity varies, as a rule, between 1004 and 1010, 
though it. may approach the lower physiological limit, or sink 
lower than in any other disease, viz., to 1002, and even to 1001. 
This low grade of specific gravity is not the result of an absence 
of solid urinary constituents, but of the relatively too great 
amount of water with which they are diluted. Comparatively 
there is as great an amount of solid urinary constituents excreted 
as in healthy persons, at times even a greater. A diminished 
amount occurs only exceptionally and temporarily, and for any 
great length of time, or during the whole disease only in conse- 
quence of the association of some other malady. 



652 KIDNEYS. 

With the amount of urine excreted stands in direct proportion 
the thirst of diabetic patients; it is almost inappeasable. As a 
very peculiar phenomenon may be mentioned a great flow of 
saliva at the same time in a case observed by Kuelz. The skin 
is generally dry and the temperature insignificantly lowered, but 
on the other organs and on the general health, diabetes insipidus 
has, so far as its direct influence is concerned, no effect worth 
mentioning, if the patients are allowed to drink freely. A sudden 
deprivation of drink may seriously endanger the life by the dry- 
ing of all the tissues, and would cause besides a scarcely endurable 
distress to the patient. 

Diabetes insipidus is much more frequently observed in youth 
and middle age than in later life. As Exciting Causes have been 
mentioned: injuries of the skull, violent and sudden emotions, 
chronic diseases of the brain and spinal cord, and a single ex- 
cessive ingestion of cold beverages or other fluids. The patients 
very rarely die of this disease if uncomplicated ; it may last for 
years if not an intercurrent disease, or the malady in the course 
of which the diabetes has arisen, and which is to be regarded as 
its cause (affections of the brain or spinal cord), terminates in 
death. On the other hand recovery has been sometimes brought 
about by an intercurrent disease, by pregnancy, etc. 

THERAPEUTIC HINTS.— The single case will have to be studied, 
and it is quite likely that a remedy might be found to suit the 
case without having the two prominent signs of the disease: 
"profuse urination and insatiable thirst," in a very high degree. 
The following remedies have been recommended: Apis, Bellad., 
Cepa, Nitrum, Phosph. ac, Squilla. Compare also diabetes 
mellitus. 

Hematuria, Passing Blood with the Urine. 

The blood mixed with the urine maj T be derived: 
1. From the substance of the kidney. — In this case the coagula 
present will be few, if the hematuria be produced by venous 
stasis; there will be a large number of renal easts, entangling 
blood-cells, present, if the bleeding be caused by inflammation of 
the kidneys ; and there will be profuse bleeding as leads to the 
formation of large clots in the pelvis of the kidney or in the 
bladder, only in the rare instances of traumatic lesion of one 



H/EMATURIA. 653 

kidney (for example, crushing or rupture of a kidney by a kick or 
the like), or in cases where a highly vascular cancer has grown 
into the pelvis of the kidney. 

2. From the pelvis of the kidney. — In this case the hemorrhage 
may be more profuse and form blood-clots corresponding to the 
shape and size of the calices, being most generally caused by 
renal calculi, preceded by renal colic and attended with calcareous 
deposits in the urine. If the entire pelvis of a kidney be filled 
with blood or with masses of cancer, it may happen that the 
corresponding ureter becomes blocked up and distended with a 
thrombus, which assumes the shape of the ureter, measuring 
often more than a finger's length and being of about the size and 
shape of a lumbricoid worm when finally passed. 

3. From the bladder. — In this case the blood-clots may form of 
so large a size that they cannot pass through the urethra without 
being first compressed by the contraction of the bladder or broken 
up by instruments. Haemorrhages of this kind may be caused by 
traumatic lesions (urinary calculi, external violence upon the 
bladder), by catarrh and ulceration of the bladder or by sup- 
pressed hsemorrhoidal or menstrual flow. 

4. From the prostate gland or urethra. — In this case the blood 
often discharges from the urethra without micturition and on 
examination will reveal the sore and swollen parts from which it 
derives. Its causes are most frequently external injuries or 
inflammations, especially gonorrhceal. 

The presence of blood in the urine can best be demonstrated 
by the microscope, which shows the cells in the sediment. How- 
ever, there are cases where only the coloring matter of the blood 
is present, but no cell, where, therefore, a dissolution or destruc- 
tion of the blood-corpuscles has taken place, as in the case of 
graver forms of typhoid fever, in haemorrhagic small-pox, in 
scorbutus, in morbus maculosus Werlhofii, in septicaemia and in 
poisoning by phosphorus, arsenic and its compounds and sul- 
phuric acid. The source of the bleeding in these cases has been 
traced to one or the other kidney pelvis, or, more rarely, to both, 
or to the bladder, or the dissolution of the red cells has taken 
place even before they leave the renal vessels. 

The Causes of renal haemorrhage, apart from the effects of 
injuries and cancerous growths, are: different kinds of inflamma- 
tions of the kidney substance; active congestion, like that produced 
by turpentine or cantharides, or in some persons by asparagus, 



654 KIDNEYS. 

or in rare cases by the action of cold upon the integuments of the 
body; by venous or passive congestion, like that although but rarely 
induced by cardiac insufficiency, or by heemorrhagic infarction 
of the kidney, the result of embolism in consequence of heart 
disease. 

THERAPEUTIC HINTS.— Arnica, when caused by external vio- 
lence. 

Arsen., haemorrhoids of the bladder; very painful micturition; 
scanty secretion; burning pain in the urinary organs; paralytic 
symptoms of the bladder; great anguish and restlessness: disso- 
lution of blood-vessels. 

Calc. carb., in chronic cases; hemorrhoidal affections; polypi; 
leucophlegmatie persons. 

Camphora, after irritating drugs, especially cantharides, and 
after exanthematic fevers. 

Canthar., violent cutting, pressing and crampy pains in the 
bladder, extending into the urethra and into the kidneys; stran- 
gury, burning pain before, during, and after micturition: cylin- 
drical exudations in the urine; pain increased from drinking 
water, even from the sight of water. 

Colchic., after being drenched when sweating. 

Chim. mac, in consequence of severe and long-continued gonor- 
rhceal inflammation. 

Crotal., haemorrhage from all the orifices of the body. 

Eriger., empirically used, without any characteristic indica- 
tions ; gonorrhoea. 

Hamam., haemorrhoids of the bladder; passive congestions. 

Ipec, profuse bleeding, with fainting, deadly paleness, sickness 
of the stomach; oppression of the chest. 

Laches., the urine looks black like coffee-grounds : scarlet fever. 

Lycop., especially in connection with gravel or chronic catarrh. 

Mercur., painless discharge of blood : also very violent urging 
to urinate, and painful micturition, whereby sweat easily breaks 
out. 

Mezer., crampy pain in the bladder; and, after that, bloody 
urine is voided. 

Millefol., pain in the region of the kidneys, with chilliness, ne- 
cessity to lie down ; the blood forms a sediment in the vessel 
like a bloody cake; pressive pain in the urethra during the flow 
of blood. 



HEMATURIA. 655 

Nitr. ac, according to Goullon, specific in active haemorrhage, 
also after mercury; urging after micturition, with shuddering 
along the spine during micturition; gonorrhceal affections; dis- 
solution of blood-corpuscles. 

Nux vom., after the abuse of alcoholic stimulants, or allopathic 
drugs; suppression of hemorrhoidal and menstrual discharges; 
full, tensive feeling, pressure, and distention in the abdomen, 
loins, and region of the kidneys; signs of stagnation in the por- 
tal circulation. 

Phosphor., dissolution of blood-corpuscles; after sexual excesses; 
after poisoning with turpentine; hoemophiles. 

Pulsat, drawing, cutting pain around the navel into the small 
of the back; penis and scrotum drawn up; crampy pain in the 
right leg from the knee to the groin. 

Secale, passive hemorrhage; blood thin; blood-corpuscles want- 
ing in consequence of dissolution; or painless discharge of thick, 
black blood in consequence of kidney disease; coldness of the 
body ; cold perspiration on forehead ; great weakness. 

Sulphur, after suppressed cutaneous eruptions and hoamor- 
rhoidal discharges; stinging and burning in the urethra. 

Tereb., the blood is thoroughly mixed with the urine, form- 
ing a dirty, reddish-brown or blackish fluid, or a coffee-ground- 
like sediment; burning, drawing pains in the kidneys; pressure 
in the bladder, extending up into the kidneys when sitting, dis- 
appearing when walking about; before urination, pressing and 
straining in the bladder when sitting, going off when walking; 
burning in the bladder, worst during micturition ; in complica- 
tion with scorbutic affections, and if caused by living in damp, 
moist dwellings. 

Uva ursi, constant urging to make water and straining, with 
discharge of blood and slime; or constant straining without any 
discharge at all, or only a few drops of urine, after this cutting 
and burning in the urethra, which is succeeded by a discharge of 
blood; hard stools. 

Ziucum, vicarious bleeding through the urethra in consequence 
of suppressed menstruation, with pain in the bowels, diarrhoea, 
and night-cough with expectoration of mucus. 

Compare also the corresponding diseases, of which Heematu- 
ria may be the consequence. 



656 KIDNEYS. 

Albuminuria. 

Albumen in the urine is not only derived from the kidneys ; it 
may come from the renal pelves, from the ureters, from the blad- 
der, or even from the urethra, when the mucous membrane of 
these passages has become inflamed, or when some abscess has 
burst and poured its matter into these channels; but then the 
percentage quantity of albumen present is only trivial. A highly 
albuminous urine has been observed after the application of large 
Spanish fly-blister, in consequence of the inflammation of the 
urinary passages caused thereby. 

A transitory presence of albumen in the urine, secreted by the kid- 
neys, is usually due to an abnormal increase of the blood-presswre 
with perfectly healthy kidneys, as we find, for instance, in heart dis- 
ease, especially mitral stenosis, or extensive muscular degenera- 
tion, in pleuritic effusions, in obliteration of several branches of the 
pulmonary artery, as follows upon cirrhotic degeneration of the 
lung substance, in emphysema. Still, as a rule, the above affec- 
tions of the respiratory organs do not often lead to congestive 
albuminuria. Much more frequently we meet albuminuria, as an 
entirely temporary symptom, daring attacks of severe fever, as occur 
in the course of severe angina, in pneumonia, in typhoid fever and 
the congestive stage of the acute exanthemata, in pyaemia, and occa- 
sionally in cerebrospinal meningitis. This febrile albuminuria is 
not attended with any specific disease of the kidneys, and must, 
therefore, not be confounded with albuminuria in consequence of 
acute diffuse nephritis, which so often occurs in diphtheria, relaps- 
ing and scarlet fever. This inflammatory albuminuria is the 
prominent symptom of inflammation of tJie kidneys, and especially 
that form which runs a chronic course. It furnishes the largest 
percentage amount of albumen to the urine, which we find also 
usually containing, at the same time, fibrine and white and red 
blood-cells. It seems that by the inflammatory process the walls 
of the capillaries within the glomeruli are so changed as to con- 
stitute a special perviousness to albuminous substances from the 
blood. Other diseases of the kidneys, such as fatty degeneration 
of the renal epithelium, cirrhosis, granular atrophy, amyloid dis- 
ease of the kidneys, are not particularly characterized by the 
presence of albumen in the urine, although it may not entirely 
be wanting in these affections. It is the diffuse inflammation of 
the kidneys (the acute and especially the chronic form) which 



URiEMIA. (i")7 

furnishes the largest amount of albumen to the urine, and to 
which the term albuminuria is particularly applicable. 

THERAPEUTIC HINTS.— According to Buchner, when in con- 
sequence of gonorrhoea or syphilis: Thuja, Sabina, Nitr. ac, 
Aurum, Cuprum, Tart, emet, (Natr. sulph., Benz. ac, Kali bichr.). 

Nitr. ac, worse at night; nausea; sour taste; bilious diarrhoea 
or constipation; dry skin; fever; headache; dull systolic sound 
of the heart (similar to Arsen.); pressure in the kidne}^s; turbid, 
fetid urine; oedema of the feet. 

Albuminuria being merely a symptom, but pre-eminently a 
symptom of acute and chronic nephritis, further and special 
hints will be given in these chapters. 

Uraemia. 

Notwithstanding the most strenuous efforts by a host of in- 
quirers to discover the essential nature of uraemia, only conflict- 
ing views have thus far been the result of the labors of the dif- 
ferent experimenters. The most probable of all theories seems to 
be this, that " urcemia arises in consequence of imperfect depura- 
tion of the blood in renal disease, the results of the retention in 
the blood of the dross of the capillary interchanges, namely, 
nitrogenous substances and specific urine contents." (Bartels.) 

Acute uraemia, in acute as well as chronic kidney diseases, mani- 
fests itself in the form of epileptic convulsions, which are succeeded 
by coma or, in some instances, by a condition of maniacal excite- 
ment. Not unfrequently a series of such epileptic attacks termi- 
nate at last in death. At times these ursemic fits are preceded 
by dropsy, dyspepsia, obstinate vomiting, and even amaurosis, which 
latter, however, may subside as suddenly as it comes. 

In the Chronic form of uraemia the epileptiform fits are usually 
absent or amount only to twitchings of certain groups of muscles, 
or they close the scene after long-continued, complete coma. The 
principal symptoms are increasing somnolence, apathy, or stupefac- 
tion, advancing at last to complete coma, frequently preceded by 
stubborn and incessant vomiting of masses which contain carbo- 
nate of ammonia. Often there is in this form a most tormenting 
itching of the skin, which compels Uie patient to scratch himself 
incessantly, even when lying in a state of unconsciousness. This 
symptom has been observed in patients who had crystals of urea 
42 



658 KIDNEYS. 

upon the surface of their skins, or exhaled a urinous odor from 
their persons. Lastly there have been observed in chronic renal 
affections, a long while before the fatal termination, paroxysms of 
asthma, most frequent at night, with intervals of complete freedom. 

THERAPEUTIC HINTS according to Buchner : 

Main remedies : Arsen., Cuprum, Phosphor., Aurum, Tereb. 

Cuprum, eclamptic form; alternation of convulsions and ner- 
vous asthma with talkative delirium, which is interrupted by 
amaurosis or deafness ; the most violent paroxysms are followed 
by apathy and greatest indifference. During the paroxysm : face 
distorted, often red; eyes projecting, staring; spasms most promi- 
nent in the extensors ; tongue and breath cold ; long, shrill 
screams ; finally exhaustion, sweat, torpor, and cessation of con- 
vulsions. 

Arsen., in the narcotic form, with oedema of the brain. 

Phosphor., where there is acute atrophy of the brain and me- 
dulla oblongata. 

Hydr. ac, action of heart diminished ; pulse accelerated, soft ; 
stagnation of circulation in heart and lungs ; palpitation, with 
indescribable anguish and dyspnoea; depression of sensibility; 
first convulsions and afterwards paralysis ; extreme apathy ; slow 
moaning breathing ; rattling in trachea ; paralysis of larynx or 
sudden paralysis of heart. 

Nicot, paralysis of diaphragm ; indifference ; want of reaction ; 
cold forehead ; thirstlessness ; serous transfusion in the intestines. 
without diarrhoea ; want of secretion in liver and kidneys. 

Acute Parenchymatous Nephritis. 

This is the First stage of Brighfs disease of many writers, or albu- 
minous nephritis of others, or the acute desquamative nephritis of 
Johnson, or Traube's hemorrhagic nephritis, or the catarrhal of 
some, and the croupous nephritis of other recent pathological 
hand-books. 

Its Pathological Changes consist in the following : dropsical 
effusion into the subcutaneous cellular tissue, at times also into the 
pleura, the pericardium, or the peritoneal cavity ; still less fre- 
quently extensive pulmonary oedema; and rarest of all oedema 
of the mucous membranes of the folds at the upper part of the 
larynx. The kidneys are enlarged and swollen, especially the 



ACUTE PARENCHYMATOUS NEPHRITIS. 659 

cortical substance, so that the capsule is tightly stretched; the 
color of the cortical substance on section is paler than normal ; 
it has a dull, grayish-red aspect, and gives a doughy feel; the 
glomeruli distended with blood, contrast with the paler ground 
as dark red points and streaks ; the pyramids are always greatly 
congested, sometimes bluish-red in color. In other cases no very 
essential deviation is exhibited from the normal appearance of 
the kidneys, with the exception of the swelling of the cortical 
substance, and even this is in some cases, when the patient died 
from other causes than the attending nephritis, very slight in de- 
gree. Between these extremes many differences in degree appear 
which correspond to the differences in the intensity of the func- 
tional disturbances observed at the bedside previous to death. 

The epithelial cells are cloudy and swollen, owing to a deposit 
of granular masses in them ; the interstices between the renal 
tubules, which are distended and dilated by the swelling of their 
epithelial lining, appear wider, and contain lymphoid elements 
in varying numbers; there appear drops of fat in the cellular 
stroma, and in more protracted cases yellow patches seem to in- 
dicate fatty degeneration. In all cases there is an infiltration of 
the epithelial cells and an albuminous transudation from the 
blood-vessels. Acute cases are usually attended with haemor- 
rhages into the tubuli uriniferi, where they form blood-casts, 
which are also found in the urine ; also homogeneous, small and 
pale cylindrical plugs have been observed filling here and there 
the lumina of the tubuli. 

The Etiology of acute inflammation of the kidneys embraces 
specific and mechanical causes. 

As Specific Causes must be mentioned : poisoning with can- 
tharides and similar irritating drugs ; but scarlet fever is the most 
common cause. Yet not all scarlatina epidemics furnish a like 
percentage of this disease. For although malignant epidemics, 
generally speaking, show the largest percentage, yet there are 
epidemics in which even bad cases produce no nephritis, and 
others where quite light cases are followed by it ; and this is not 
referable to any imprudent exposure of the patient, as the disease 
may attack a child which never has left the bed. The onset of 
the disease, if an average be taken, occurs about the twentieth 
day from the first appearance of the rash ; the earliest date of its 
occurrence was the tenth, the latest the thirty-first day. With 
this renal inflammation we must not confound febrile albuminuria 



660 KIDNEYS. 

(compare Albuminuria), which generally appears at the height 
of the exanthem and disappears again with the subsidence of the 
fever. 

Next to scarlet fever follows diphtheria as a specific cause of 
nephritis ; and like scarlet fever it does not excite a renal affec- 
tion in every instance, nor does the renal affection stand in direct 
proportion to the intensity of diphtheria. 

Measles, rubeola (Rotheln), small-pox excite nephritis far less 
frequently than either scarlet fever or diphtheria, but relapsing 
fever is, according to Ponfink, almost without exception attended 
by nephritis. Besides these principal specific causes are yet to 
be mentioned : erysipelas, carbuncles, phlegmons, profuse suppura- 
tions in cavities where decomposition of the pus begins in conse- 
quence of the admission of atmospheric air, and very rare cases 
of dysentery. 

The Mechanical Causes which act upon the vessels and thus 
effect the circulation of the blood through them, are: Cholera, 
which leads to complete stoppage of the circulation in the kid- 
neys and a consequent anuria; catching cold, which contracts the 
cutaneous vessels and drives the blood into the internal parts of 
the body where it causes an elevation of the blood-pressure ; ex- 
tensive burns of the surface of the body, which cause a general de- 
pression of the temperature of the body in consequence of the 
great loss of heat; abdominal typhus and other diseases attended 
by an unbroken continuous high temperature, which causes dila- 
tation of the vessels and other alterations in the walls of the ves- 
sels (of rare occurrence) ; and acute rheumatism, when complicated 
with endocarditis. Pregnancy also is a cause of acute parenchy- 
matous nephritis. Usually its appearance takes place in the last 
months of pregnancy, and it attacks primiparae more frequently 
than women who have already borne children. Its first symp- 
tom in the majority of cases is dropsical swelling not confined to 
the lower extremities, but attacking face and hands as well. The 
percentage of albumen is greater than in nephritis of any of the 
other causes, and its fearful terminal symptoms: epileptiform con- 
vulsions, amaurosis and maniacal excitement are well-known under 
the name of eclampsia gravidarum jmrturicntium ct pucrperarum. 
However it must not be surmised that every case of eclampsia 
must be ascribed to disease of the kidneys and uraemia, not even if 
there should be found albumen and a few casts in the urine after 
the attacks, inasmuch as cases of this kind have been observed 
which showed after death not a sign of diseased kidnevs. 



ACUTE PARENCHYMATOUS NEPHRITIS. G61 

The Symptoms of acute parenchymatous nephritis are in the 
majority of cases accompanied by the symptoms of the primary 
disease — the febrile movement especially must often be ascribed to 
the latter. In cases from catching cold, however, the temperature 
has been observed to rise above 104° F., lasting commonly but a 
short time; the outbreak of ursemic convulsions or of secondary 
inflammatory processes, too, heighten the temperature. Aching 
pains in the lumbar region is not at all a constant symptom and 
frequently is absent altogether. But a tenderness in the region of 
the kidneys upon deep pressure is often present. Frequent and 
excessively urgent desire to micturate, with the voi dance of only a 
few drops, often of bloody urine, is also not a constant symptom 
and is apt to disappear very quickly. The quantity of urine is 
always diminished at the commencement; the urine may even be 
entirely suppressed.; later, when the case takes a favorable turn, 
the quantity increases above the normal quantity or may for 
some time alternately increase and diminish. The urine is at 
first always cloudy from the presence of urates and other elements. 
Its color is from the admixture of blood tinged reddish or is quite 
dark blackish-red, when a thick sediment of chocolate-brown 
color is formed, consisting of urates and blood-corpuscles. Its 
reaction is always acid and its specific gravity varies with the 
quantity passed. At first it may rise as high as 1031, and later, 
when the quantity increases, sink as low as 1011, 1009 and even 
1006. The urine always contains albumen, although in no case as 
much as in chronic parenchymatous nephritis, and also casts of a 
hyaline nature with epithelial cells from the tubuli uriniferi 
attached to them, or covered with small drops of fat, also white 
and red blood-globules and their debris, epithelial cells from the 
uriniferi tubules, and granular masses, the latter being probably 
the detritus of broken-down epithelial cells. 

The danger of acute nephritis consists in the retention in the 
blood of the special constituents of the urine, causing acute urse- 
mia, and in the insufficient excretion of water, which leads to 
dropsy, a symptom which is scarcely ever absent, except in very 
mild cases. The oedema commences usually at first in the lumbar 
region of the back or in the face; later often an accumulation of 
water fills the serous cavities of the trunk ; in rare cases there is 
oedema of the glottis. 

Vomiting is occasionally at the commencement severe and 
obstinate ; at a later period it may be ursemic in its character. 



662 KIDNEYS. 

The Prognosis of acute nephritis depends much upon the 
cause from which it is derived. That following scarlet fever is 
the most dangerous. 

Its transition to a chronic renal affection is only exceptional ; 
that following catching cold or articular rheumatism is perhaps 
the most prone to chronic renal troubles. Total suppression of 
urine, except in cholera, is a very grave symptom, often fatal; 
ursemic attacks do not always prove fatal. 

THERAPEUTIC HINTS.— In complication with scarlet fever com- 
pare : Apis, Arsen., Ascl. syr., Bellad., Bryon., Colchic, Helleb., 
Kali carb., Laches., Lycop., Mercur., Rhus tox., Secale, Seneg., 
under the head of Scarlet Fever. 

After the abuse of cantharides, or balsam of copaiva, the best 
antidote is Camphora ; after turpentine, Phosphor. 

Aeon., high fever; restlessness; dark, scanty urine; conse- 
quence of exposure to cold. 

Apis, after scarlatina or diphtheria. 

Arsen., after burns. 

Bellad., skin sweaty ; renal region very tender to pressure ; urse- 
mic spasms. 

Canthar., high fever; pulse frequent and hard; drawing, tear- 
ing pain in loins and testes, worse from motion; sometimes in 
spells, stopping breathing; micturition exceedingly painful, drop 
by drop; scanty, dark urine, with burning in the bladder and 
urethra ; the urine contains cylindrical casts of fibrinous exuda- 
tion, epithelial cells and blood, and is therefore easily cyagula- 
ble ; constipation ; ura?mic, cerebral symptoms, like stupor, 
numbness; after exposure to cold, or mechanical injuries; com- 
plication with prostatic derangements, inflammation of the blad- 
der, and stricture of the urethra ; after burns. 

Chelid., with pneumonia on right side. 

Balsam of Copaiva and Cubebs have been observed to cause in- 
flammation of the kidneys, though their sphere of action is not 
sufficiently known. 

Colonic., after getting thoroughly wet ; articular rheumatism. 

Helon., in connection with pregnancy, and symptoms of ap- 
proaching convulsions. 

Hepar is recommended by Kafka on the ground of its having 
a decided relationship to croupous exudations elsewhere. 

Kali carb., tensive pain in the region of the left side; swelling 



CHRONIC PARENCHYMATOUS NEPHRITIS. bb«5 

of the inguinal glands; oedema of the left foot, extending gradu- 
ally to the right foot and upwards over the whole body; oedema 
of upper eyelid; blackish urine, which, on shaking, foams, and 
on standing leaves a thick, reddish, slimy sediment; frequent, 
soft, palish evacuations from the bowels ; after a blow upon the 
left side and staying for hours in wet clothes. 

Kali hydr., scanty, dark urine; painful micturition; sediment 
dirty, yellowish ; great thirst ; heat in the head. Likewise re- 
commended by Kafka on the same ground as Hepar. 

Laches., after scarlet fever or diphtheria ; dark, almost black 
urine; difficulty of breathing. 

Merc, corr., great dyspnoea; colics and tenesmus; offensive secre- 
tions; puffiness of face and feet. 

Phosphor., the skin is pale and anaemic; frequent watery diar- 
rhoea; in complication with pneumonia, bronchial catarrh, ulcer- 
ation of the bones, amaurosis. Antidote to turpentine. 

Rhus tox., tearing pain in the region of the kidneys; cedema- 
tous swelling all over ; after exposure to wet. 

Tereb., scanty secretion of dark, (occasionally) bloody urine, 
which coagulates on addition of nitric acid under the application 
of heat; oedema all over; intestinal catarrh and diarrhoea; bron- 
chial catarrh, with expectoration of much mucus. 

Amauratic symptoms may especially require: Apis, Arsen., Col- 
chic, Hepar, Gelsem., Kalmia, Merc, corr., Phosph. ac, Plumbum. 

Chronic Parenchymatous Nephritis. 

This is the Second stage of Bright's disease of most writers, or the 
non-desquarnative nephritis of Johnson. Being as stated in the 
last chapter occasionally developed from acute nephritis, its 
anatomical changes may certainly be expected to correspond to a 
certain extent to those described there. We find the kidneys 
still more enlarged than in the acute form, and being exceedingly 
anaemic, they look strikingly pale, almost white, with a strong 
tinge of yellow, wherefore Wilks called them the "Large white 
kidney." With this yellowish white color of the surface as well 
as of the cortical substance contrast sharply the bluish-red, 
stellate venous radicles and the enlarged, but often dark-red 
pyramidal substance. The microscopical examination reveals 
the same changes as described under acute nephritis. The long- 
continued inflammatory hyperplasia of the interstitial tissue 



0G4 KIDNEYS. 

finally results (in consequence of the pressure which the callous 
tissue exerts upon the blood-vessels), in a gradual obliteration 
of the glomeruli and a secondary atrophy of the secreting paren- 
chyma of the kidneys, although such kidneys are rarely found 
much smaller tban normal kidneys. In cases like these the left 
ventricle of the heart becomes hypertrophied. The bodies are 
always more or less dropsical. 

The Etiology of chronic nephritis shows a small percentage of 
cases to have grown out of some acute forms, but the great ma- 
jority of cases develops insiduously during the course of affections 
that are accompanied by persistent suppuration, such as diseases of the 
bones and joints, the more severe forms of inveterate syphilis, 
phthisical, ulcerative destruction of the lungs; in consequence of long- 
continued exposure to cold and moisture (a sudden catching cold is 
more apt to produce acute nephritis, and therefore almost all 
writers on the causes of chronic Bright's disease, mention living 
in cold and wet habitations, occupations in which the body is 
frequently wetted and chilled through, etc., as one of the causes); 
and in consequence of marsh miasm. Young persons are deci- 
dedly more frequently attacked with this disease than those who 
are advanced in years. 

Symptoms of chronic parenchymatous nephritis are on account 
of its insidious inroad at first entirely wanting; not even a pain 
is felt by those persons who enjoj'ed previous good health. 
When no examination of urine has been instituted, the first sign 
that betrays the malady is dropsy, and at the same time the 
patient appears pale and anaemic, and complains of losing bodily 
strength. The dropsy beginning either in the feet or in the face, 
extends gradually over the whole body; the external genitals in 
particular, and also the abdominal walls are greatly swollen, 
before any perceptible quantity of fluid is collected in the peri- 
toneal, pleural or pericardial cavity. The general anasarca de- 
velops to a higher degree than in any other disease of the kidneys, 
often to such an extent that the epidermal layer bursts, and the 
dropsical fluid trickles out of the cracks in enormous quantities. 
In such places where the corium has been deprived of its epi- 
dermis, frequently follows a gangrenous destruction of the parts. 
Even the lining mucous membrane of the intestinal tract becomes 
involved in the dropsical swelling, which manifests itself by 
vomiting of watery masses and profuse watery diarrhoea. The 
advance of the dropsy will not be checked until the excretion of 



CHRONIC PARENCHYMATOUS NEPHRITIS. 665 

urine again becomes abundant, and even then it may take a long 
time before it entirely and permanently disappears. When this is 
accomplished the patients appear skeleton-like, for not only the 
subcutaneous adipose tissue, but also the muscles have been 
reduced to the merest remnants; there is extreme anaemia, 
Should complete recovery take place, which is rarely the case, 
the convalescence is very slow. Dropsy is absent only in the 
very mildest cases. 

The urine invariably contains albumen, and when the disease 
is at its height,, in greater quantity than under any other cir- 
cumstances; it also contains casts of various description, epithe- 
lium, debris, white blood-cells, urates and uric acid. Red blood- 
corpuscles appear only transitorily in cases which commenced 
acutely, for instance, after catching cold. In consequence of and 
according to the presence and quantity of these contents, the 
color of the urine is ordinarily dirty brown, and darker in pro- 
portion to the smallness of the quantity. The scantier the excre- 
tion, the more clouded it is — even before cooling. The urates are 
held in suspension after cooling, when there is a large amount of 
albumen present, and make the urine thick and muddy. The 
uric acid crystals fall to the bottom and adhere to the vessel. 

The specific gravity of the urine is highest at the height of the 
disease — in some cases above 1040, and it falls below the normal 
weight as soon as a more abundant excretion of urine sets in, 
even before the diurnal quantity of urine has reached its 
normal point. With this fall in specific gravity is not found a 
like fall in the amount of albumen, while it may be taken as a 
rule that the relative quantity of urea to a certain extent rises 
and falls with the rise and fall of the specific gravity of the urine. 

The pulse at the beginning is usually remarkably slow, full 
and tense, and the heart-sounds loud and sharp, in persons who, 
previous to the attack, were robust and vigorous, but later be- 
comes weaker and more frequent, while in enfeebled persons the 
pulse and action of the heart are weak from the first. 

Respiratory difficulties set in only in consequence of dropsy in 
the serous cavities, or of pulmonary oedema. 

Digestion may and may not be disturbed ; but vomiting and 
diarrhoea are frequent symptoms when the dropsy is at its height; 
the latter may terminate in secondary dysentery and ulceration 
of the bowels. 

Epileptiform attacks, coma, amaurosis, are much less frequently 
observed than in acute nephritis. 



666 KIDNEYS. 

When secondary atrophy has taken place, a hypertrophy of the 
left ventricle develops, with its train of symptoms, in consequence 
of the obliteration of so many peripheral arterial branches. 

The Prognosis of this disease is a bad one, when the affection 
has lasted already for a long time, or is complicated by some in- 
curable constitutional or organic disease, or when the urine is 
very scanty, high in specific gravity, with a large amount of 
albumen ; or when the urine, after the subsidence of dropsy, is 
pale, of low specific gravity, never even temporarily attaining a 
normal density, and still containing albumen and casts in extra- 
ordinary number, with commencing secondary hypertrophy of 
the left ventricle ; or when oedema of the glottis or lungs, pneu- 
monic infiltrations of the pulmonary tissue, phlegmonous inflam- 
mations of the subcutaneous cellular tissue are added to the 
already poor condition of the patient. 

THERAPEUTIC HINTS.— Compare Acute Nephritis. 

Arg. nitr. is said to have caused albuminuria. 

Arsen., great anxiety at night, driving out of bed ; vomiting of 
brownish masses, with violent pain in the bowels ; pressure and 
burning pain in the stomach ; swelling of the genitals ; palpita- 
tion of the heart, left side of heart predominantly affected. 

Aunim, when complicated with gout, renal calculi, protracted 
suppurations, syphilis, liver degenerations, mercurial affections. 
(Buchner.) Melancholy; desires death. 

Benz. ac, gouty diathesis, with strong-smelling urine. 

Brachiglottis repens, (puke-puke), highly recommended by Dr. 
C. F. Fisher. 

Bryon., intercurrent inflammation and exudation of serous 
membranes. 

China stands next to Arsen. (D. Thayer.) 

Colonic, damp rooms; relapses from taking cold in damp 
weather ; suppressed perspiration ; affection of salivary glands ; 
cannot bear the smell from cooking. 

Digit, peculiar, seemingly rheumatic pains, and catarrhal affec- 
tions of the lungs, with serous secretions. 

Helleb., indifferent, sad, silent; anasarca and effusion in the 
pericardium or pleura ; black urine. 

Hepar, after abuse of mercury; renal region sensitive to slightest 
touch ; incessant, painful urging to urinate, with voiding of a 
few drops of thick urine; fever; thirst; colliquative diarrhoea; 
night-sweats. 



CONNECTIVE TISSUES OF KIDNEYS. GG7 

Lycop., hydropericardium ; ascites ; anasarca, especially lower 
limbs ; oozing of water from sore places of the cedematous legs ; 
urine dark red, scanty, albuminous, with strangury. Very irrit- 
able after sleep ; scarlet fever. 

Nitr. ac, pulse intermits every tbird or fourth beat; urine 
scanty, dark brown, smelling strong, like horses' urine; turbid 
urine ; syphilis ; abuse of mercury. 

Phosphor., tuberculosis ; diseases of right heart and of the pul- 
monary artery. (Buchner.) 

Phytol., after diphtheria in rheumatic and syphilitic patients. 

When in consequence of exposure to cold and wet : Calc. carb., 
Colonic, Dulcam., Kali carb., Mercur., Nux vom., Rhus tox., 
Sepia. 

"When in consequence of suppuration, cachectic states of the 
system: Asaf., Aurum, Calc. phosph., China, Ferrum, Hepar, 
Mezer., Phosphor., Silic, Sulphur. 

Buchner recommends for : 

Anasarca: Helleb., Arsen., Dulcam. 

Hydrothorax: Arsen., Bryon., Colchic. 

Hydropericardium: Digit., Arsen., Lycop. 

Ascites: Arsen., Aurum. 

Affections of the liver: Cuprum, Lycop., Aurum. 

After taking cold: Dulcam., Arsen., Calc. carb. 

Interstitial Inflammation or Induration of the Connec- 
tive Tissue of the Kidneys. 

This is the so-called Third stage of Bright's disease of many 
authors, or genuine contracting kidney, or the granular atrophy of 
the kidney, or renal cirrhosis, or renal sclerosis of other writers. 

It is, according to Bartels, " the result of a primary growth or 
proliferation of the intertubular connective tissue, and com- 
mences and pursues its course quite independently of the other 
forms of renal inflammation previously described. It is, in fact, 
an altogether independent form of the disease. This process 
leads from its commencement steadily to the dwindling of the 
substance of the gland, a wasting preceded by no anterior inflam- 
matory swelling of the organ. And this wasting does not affect 
the whole mass of the cortical substance simultaneously, but 
commences in scattered spots upon the surface of the kidney and 
extends very gradually from the spots first implicated both upon 
the surface and into the depth of the organ." 



6GS KIDNEYS. 

Post-mortem examinations show, in most cases, both kidneys 
atrophied, principally in their cortical substance, though the 
medullary substance also takes part in it. The pelvis is occa- 
sionally distended to a pouch, but oftener drawn together into 
narrower dimensions than normal. The capsule is tough and 
thick, and portions of the renal substance are always found ad- 
hering to it. The surface of the gland, after being freed from the 
capsule, appears finely granulated, and its entire substance is 
very tough ; occasionally small cysts are found in the scanty cor- 
tical substance. The color of the kidneys is sometimes dark col- 
ored throughout, at other times pale, nearly grayish-white, but 
in no case is that marked yellow color exhibited which we find 
in the secondary contraction after nephritis. The microscope 
shows an extensive wasting away of the glandular structure 
proper, of the renal tubes with their epithelium and of the ves- 
sels attached to them. There are extensive layers of very firm 
and chiefly fibrinous organized connective tissue, and between 
them here and there some well preserved renal tubules. The 
great number of wasted glomeruli appear like dark round bodies, 
in which the outline of the capillary coils is still plainly percep- 
tible. The cysts in the cortical substance above mentioned, ap- 
pear to be developed from partially dilated and strangulated 
renal tubules, the contents of the tubes having subsequently suf- 
fered colloid metamorphosis, and the granules upon the surface 
of the kidney seem to be the remains of renal tubuli still beset 
with epithelium. However, such general degeneration is not 
found in every case. In some only a partial contraction has 
taken place, while other portions retain their normal appearance; 
neither are both kidneys always affected alike. In almost every 
instance, however, there is found hypertrophy of the left ventricle of 
the heart. Other features often met with are: retinitis cdbuminu- 
rica, thickening of the skull cap, apoplectic effusions, and occasionally 
dropsical effusions usually of small amount. 

The Etiology of renal cirrhosis is not very clearly understood. 
It is of rare occurrence in youth, more frequently in middle life, 
and at any age most frequent in the male sex. As exciting 
causes are mentioned : spirituous liquors, especially gin, lead- 
poisoning, gout and inveterate gonorrhoea. 

Symptoms. — Its commencement eludes diagnosis. As the first 
symptom which draws attention to itself is the frequent desire to 
pass water, especially at night, and without pain or ache. In some 



CONNECTIVE TISSUE OF KIDNEYS. 669 

cases the patient experiences occasional attacks of palpitation, 
accompanied sometimes with vertigo, or a sense of great un- 
easiness, or suffocation, or want of breath, also principally at 
night. In such cases the heart will be found hypertrophied. 
There also occur occasional paroxysms of headache under the 
form of hemicrania, recurring often and lasting for several 
days. A terrible itching of the skin with more or less ex- 
tended so-called rheumatic pains sets in frequently toward the 
end of life, but visual disorders under the form of retinitis albu- 
minuria, also occasionally a most repulsive smell of the breath are 
symptoms of an earlier stage. At first, appetite and strength are 
not affected, later, however, the appetite fails, especially for meat- 
diet, with occasional vomiting after eating, and an increased 
thirst for large quantities of fluid, with increased excretion of 
urine. This is followed by emaciation, anaemia, and loss of 
strength; the skin acquires a peculiar dryness and assumes a dirty 
faded color, and the sexual power is either greatly diminished or 
lost altogether. The larger number of patients die either of 
anaemia or apoplexy , or of inflammatory exudations into the serous 
cavities, or of inflammatory infiltration of the lung tissue, or else of 
erysipelatous and phlegmonous inflammations of the general surface 
of some part of the body. Dropsy may be entirely wanting, except 
when the disease advances to its most extreme grade, in which 
the kidneys become incapable of performing their function, or 
when intercurrent diseases of the lungs or heart, especially mi- 
tral insufficiency, bring it about independently of the kidney 
affection. Diarrhoea is often found toward the end of the dis- 
ease, and then very profuse, watery and fetid. Haemorrhages 
from different parts of the body (nose, mouth, bronchi, stomach, 
intestines, and the skin principally of the extremities in the form 
of petechia? or ecchymoses) occur likewise in the later stages of 
the disease. But the most important indications can only be 
gained by frequent and careful examinations of the urine. "As 
a general rule, the genuine process of contraction of the kidney is as- 
sociated with polyuria. But neither does this symptom at once 
become prominent at the very beginning of the malady, nor does 
it persist absolutely to the very end of the case. In fact, in the 
progress of the disease it may entirely subside for a longer or 
shorter interval of time, whenever, from any debilitating in- 
fluence, the vigor of the heart's propulsive powers is diminished 
for a longer or shorter period, or the urinary secretion may be 



670 KIDNEYS. 

completely arrested for several clays before death, if the patient 
loses much water by any other channel, or severe collapse pre- 
cedes death for some time." (Bartels.) 

The color of the urine is pale yellow, or yellowish-green, It is 
clear without sediment, only occasionally crystals of uric acid, and 
still more rarely urates are found upon cooling. Its specific 
gravity is, as a rule, below normal, fluctuating between 1001 and 
1012, and its reaction slightly acid, but may become alkaline by 
decomposition, dietetic or medicinal treatment, or vesical affec- 
tions. It contains albumen in the vast majority of cases, though 
this abnormal constituent may be wanting at the beginning, or 
for a greater length of time during the course of the disease, or 
be absent altogether in exceptional cases. On the whole, how- 
ever, the percentage of albumen in this disease is much less than 
that furnished by the inflammatory processes in the kidneys 
before described; its amount changes greatly according to the 
mode of life, the food and the general state of nutrition, and there 
is no constant ratio between the percentage of albumen and the 
total quantity of urine. 

The percentage of solid constituents, especially that of area, is 
abnormally small; epithelial cells from the renal tubes are seldom 
found ; red blood-corpuscles, few in number, may be found scattered 
in the sediment, but never to an extent as to make the urine red 
or sooty; and white blood-corpuscles or pus-cells seem to derive 
somewhere from the mucous membrane of the urinary passages. 

The most Diagnostic Signs then of renal cirrhosis are: the large 
quantity of urine, daily secreted, its pale color, its low specific grav- 
ity, and the comparatively small amount of albumen it contains, 
combined with hypertrophy of the left heart. From this the 
secondary atrophy of the kidneys in consequence of diffuse ne- 
phritis, differs in the smaller amount of daily secretion of urine: 
in the urinary sediment consisting of numerous casts of different 
character and of large quantities of granular detritus ; and in the 
presence of considerable dropsy for a long time. 

THERAPEUTIC HINTS.— I find only one case mentioned as having 
been cured which can be classed under this head, although neither 
albuminous urine nor hypertrophy of the left heart are men- 
tioned in it, yet both may have been present according to the 
symptoms. The case is this: L. K. M., set. 52, of robust frame; 
family history good. The past and present absence of any oedema , 



DEGENERATION OF KIDNEYS. G71 

the general profuseness of urine, with all else, led to the diagnosis 
of Bright's disease, — variety, granular degeneration. Perspires 
all over the body, so soon as he gets into bed; perspiration comes 
and goes all through the night. Cough on first waking. Cough 
comes as he gets out of bed; continues until he has had his 
breakfast. It is occasioned by a sensation as if he had a "wheat 
hull" low in his throat, just behind the manubrium sterni. 
Lying on his back makes him cough ; on right side also. When 
lying on his back, feels as if fluid rolled from one side of his 
chest to the other. (Purely subjective, no fluid there.) In the 
morning, mouth and lips are dry, and lips swallow. Tongue also 
dry. Lips crack open when coughing. Drinks at night on ac- 
count of dry mouth. Oppressed for breath ; breathes with diffi- 
culty, especially after waking. Going upstairs causes it. Is 
markedly weak now. Rash as it may appear, considering that 
the sweat did not break out each time he awoke, I gave him one 
drachm of Sambuc, first dec. dil. in half a glass of water, a dessert- 
spoonful every hour. Result: No sweat that night. May 18th, 
Bryon 30 ., for pleuritic pains in the right lateral thoracic wall. 
This was an old trouble of his — sinapisms and cantharides- 
blisters having hitherto been applied for them. The action 
of Bryon. won his heart. He had thought the effect of Sambuc. 
on his night sweats "a coincidence;" but the Bryon. dispelled the 
pain inside of fifteen minutes. May 23d, his prescription was 
Plumb, met, 30th trit., a powder (two grains) every four hours. 
He has exchanged his pasty yellow look for the ruddy hue of 
health, for he is a ruddy man now again. (S. A. Jones, Am. 
Obs., Nov. 1875, p. 561). 

Compare also the previous chapters. 

Amyloid Degeneration of the Kidneys, Lardaceous 
or Waxy Kidney. 

Amyloid degeneration is scarcely ever confined to the kidneys 
alone, but exists at the same time in the spleen, the liver, the 
abdominal lymphatic glands, the blood-vessels of the mucous 
membrane of the intestines, as well as those of the various other 
organs, and is invariably the local manifestation of a general 
constitutional disease, of a cachexia which arises from prolonged 
suppuration, in consequence of scrofula, chronic tuberculosis or 
inveterate and hereditary syphilis. Intestinal ulcerations favor the 



672 KIDNEYS. 

development of the disease more than ulcers of any other mucous 
membrane. 

Post-mortem examination shows in lighter cases no abnormal 
appearances of the kidneys to the naked eye. In extreme cases 
the kidneys are greatly enlarged, heavy, tough and firm; the 
color of their surface is pale, at times almost white, and so is their 
broadened cortical substance; upon the cut surface in the cortex 
appears a peculiar polish; but there is no sign of yellow colora- 
tion, as is always observed in the equally enlarged and ancemic 
kidney of chronic parenchymatous inflammation. If a watery 
solution of iodine or iodide of potassium is applied to the cut 
surface there soon appear bright reddish-brown points and 
branching lines, denoting the Malpighian tufts and the arteries 
with their branches, which have undergone amyloid degenera- 
tion, and on adding a drop of concentrated sulphuric acid the 
reddish-broivn structures at once turn to blue. 

Amyloid degeneration often occurs together with chronic paren- 
chymatous nephritis in both kidneys, and as it is furthermore 
the result of other constitutional troubles, it is scarcely, possible 
to separate its Symptoms from those produced by the coincidental 
diseases. In fact it develops itself quite insidiously, or, so to 
speak, without symptoms. The urine, as a rule, is augmented, and 
then always clear and pale like water; but when scanty it is 
darker and occasionally clouded with urates. Its sjiecific gravity 
may sink to 1003, when passed freely, and may rise to 1030 and 
over, when passed but scantily. It contains albumen, and more at 
the beginning than later, when polyuria has set in. Casts are 
seldom found in any considerable number. Dropsy may or may 
not be present; but if it does appear it usually remains persistent, 
especially the ascites, even in spite of abundant urinary secretion. 
Diarrhoea is very common and nearly always fatal, being induced 
by ulceration, as in phthisis and syphilis. Vomiting is less fre- 
quent and consists of watery masses of a faintly acid reaction. 
Other ursemic symptoms, if the vomiting may be considered as 
such, are still rarer, and the cardiac hypertrophy is altogether 
absent, but in some cases the heart has been found small and 
atrophied. As a rule the fatal issue is brought about by gradual 
exhaustion. 

The Prognosis is entirely dependent on the fundamental dis- 
ease and its Diagnosis is always quite difficult, and in most cases 
impossible. 



SUPPUEATED NEPHRITIS. 673 

THERAPEUTIC HINTS must be derived from a study of the 
constitutional malady of which amyloid degeneration is the 
result. 

Suppurative Nephritis, Renal Abscess. 

This may be produced : 

1. By renal concretions, which irritate the renal tissue and cause 
suppuration. 

2. By injuries, for instance gunshot wounds, bruises, etc. 

3. By chronic retention and decomposition of the urine, which 
affects the renal pelvis and parenchyma almost always simulta- 
neously. 

4. By metastasis through embolism of smaller renal vessels with in- 
fecting substances, in consequence of endocarditis sinistra. 

5. By the so-called pyeemic affections. 

G. By the extension of suppurative processes from neighboring organs, 
especially from the perinephritic tissues, the psoas muscle, the 
liver, etc. 

7. By the misuse of diuretics, especially of cantharides. 

8. By unknown causes, perhaps exposure to cold, etc. 

The Diagnosis of traumatic nephritis rests upon the history of 
the case ; of all other forms it is exceedingly difficult, often im- 
possible. 

THERAPEUTIC HINTS must entirely be derived from the special 
symptoms of the individual case. 

Nephrolithiasis, Renal Gravel or Calculi; Nephralgia, 
Colica Renalis. 

Renal gravel and larger renal concretions consist of and are 
developed from both normal and abnormal ingredients of the 
urine. Renal sand consists of fine powdery deposits ; renal gravel 
at most attains the size of a pin-head ; renal stones are of larger 
size, but seldom exceed that of a bean. The chemical composition 
of these concretions is various. Of the most frequent occurrence 
are those consisting of uric acid; those consisting of urates, espe- 
cially of urate of ammonia, are found much more frequently in 
nurslings than in adults ; they are soft. Oxalate of lime calculi 
are very hard, thorny and warty, and very irritating to the tis- 
43 



G74 KIDNEYS. 

sues ; they are rare, and occur more frequently in alternate layers 
with urates. Calculi of basic phosphate of lime (bone earth) or of 
ammonio-magnesian phosphate, or of the two mixed, are white or 
yellowish-white and of not unfrequent occurrence, while concre- 
tions of carbonate of lime are very rarely found. Cystine stones are 
of a dull yellow color, with scarcely any variation in the shade ; 
they are rare; and still rarer are those composed of .xanthine, 
which have a light brown or dark brown color, and a smooth 
surface. Concretions of fibrine are the result of renal haemor- 
rhages with subsequent secretion of fibrin ; they are often found 
mixed with other kinds of concretions ; they have a dirty white 
or yellowish-brown color, and their consistency is that of wax, 
tough and elastic. We know little of the Etiology of nephroli- 
thiasis. Heredity and family idiosyncrasy, also habits of life and 
conditions of nutrition are among the predisposing causes men- 
tioned. 

Symptoms. — Renal sand usually causes no inconvenience to the 
patient ; it is washed away with the urine. Gravel and calculi 
are often attended with more or less pain in the region of the 
kidneys, and when entering the ureters may cause the most se- 
vere paroxysms of pain, known under the name of renal colic or 
nephralgia. Most usually the pain is only on one side, following 
the course of the ureter down into the bladder, and in males, into 
the corresponding testicle which is generally drawn up, often ra- 
diating to the glans penis, and causing a feeling of numbness in 
the corresponding lower extremity. These paroxysms of pain 
often alternate with remissions, but when at their height cause 
vomiting, cold perspiration, cold extremities, small pulse, great 
agonj^, collapsed features, even fainting fits and general convul- 
sions. Pregnant women often abort under these circumstances. 
The urine is voided only drop by drop, with burning in the ure- 
thra, is scanty, red, brown or blackish, exceedingly loaded with 
blood, often mixed with mucus or pus, or is suppressed alto- 
gether, with subsequent ura?mic symptoms, when the ureters of 
both' kidneys are obstructed at the same time. The urine is 
often colorless, as clear as water, when only one kidney is af- 
fected and its ureter obstructed, and it is of very rare occurrence 
that complete anuria should take place, if only one kidney be 
diseased. During the intervals of renal colic the urine shows at 
times single crystals or particles of the urinary components con- 
stituting the renal calculi. The paroxysms of extreme pain 



NEPHROLITHIASIS. G75 

cease, as soon as the calculus has completed its way through the 
ureter into the bladder; this occurs suddenly in most cases. In 
other cases the colic abates only slowly and gradually, when for 
instance the stones are of but slight consistency and crumble by 
degrees into smaller particles within the ureter. In some persons 
attacks of renal colic appear periodically and at regular intervals 
of time. The latter attacks arc milder than those previous, if the 
size of the calculi be not larger than the ones previously dis- 
charged, because the accumulation of fluids accompanying each 
attack results in enlarging the calibre of the ureter. 

Nephrolithiasis is a chronic affection. A fatal termination 
may occur when, as the result of the arrest of a renal stone dur- 
ing its passage through the ureter, a rupture of the latter takes 
place, which is followed by fatal peritonitis; or when, as the 
result of complete arrest of the urinary secretion by obstruction 
of the ureters, uramia is developed. Hydronephrosis, that is a 
dilation of the pelves and ureters by the retained urine, or sup- 
puration of the renal parenchyma in consequence of the presence 
of renal calculi, assume a very chronic course, as one sound kid- 
ney usually is capable for a long time of performing the normal 
functions of both. 

THERAPEUTIC HINTS.— A prevention of the formation of renal 
sand and calculi will be possible only by a deep study of the 
single case, and a long course of treatment based thereon. The 
physician is called in most cases only to prescribe for the present 
emergency, the renal colic, and here Homoeopathy has won many 
victories. The following remedies have been applied in many 
cases most successfully. A prescribing of opium or morphine in 
large doses or hypodermic injections is not at all the highest aim 
to which a student of Homoeopathy should aspire. 

Arnica, piercing pains as if a knife were plunged into the region 
of the kidneys; violent tenesmus of the bladder; chilly and in- 
clined to vomit. Sulphate of morphia had been given in large 
doses without relief. Arnica, 1st dec. dil., in water, relieved in 
half an hour. (A. E. Small.) 

Arsen., passage from time to time of gravel with dull pain in 
renal region, extending down to ureter; gastralgia; tickling and 
itching in urethra; difficult micturition; sediment of uric acid. 
(Bourgeois.) Urine alkaline, dark yellow, with sediment of mucus 
and crystals of urate of lime. (Schadler.) 



676 KIDNEYS. 

Bellad., spasmodic, eranipy straining along the ureter, through 
which the calculus makes its way. After opium or morphine. 

Berber., when there is red sediment in urine, pain in back, 
etc. (S. E. Xewton.) 

Canthar. high; intense pain above crest of ilium. (S. Swan.) 

Diosc, has relieved the writhing, twitching and crampv pains. 
(E. M. Hale.) 

Lycop., after Nux vom. ; colicky pain in the right side of the 
abdomen, extending into the bladder, with frequent urging to 
urinate. Urine incrusting the vessel with red sand. 

Nux vom., always the best remedy after the palliative use of so- 
called anodynes; pain, especially in the right kidney, extending 
into the genitals and right leg; nausea: vomiting; constant urg- 
ing to urinate; insufficient urging to stool; inability to lie on 
the right side ; better while lying on the back ; rising and walk- 
ing about increases the pain. 

Opium, or Morphine is given by the old school in large closes, 
to lull the pain ; it is indicated where there are pressive, squeez- 
ing pains, as though something had to force its way through a 
narrow space; shooting pains from different places into the 
bladder and testicles: vomiting of slime and bile: obstinate con- 
stipation: dysuria ; greatest anxiety and restlessness: constant 
changing position; face hot: pulse slow. 

Piper meth., pain agonizing: irresistibly impelled to try all 
sorts of motions and positions for relief, without finding it. 
(Hiller.) 

Tabac. constant deadly sickness of the stomach and retching, 
with cold perspiration : violent colicky pains in the region of 
the ureter, right or left side. 

The following may also be mentioned: Calc. urinaria, Cannab., 
Eriger., Eupat. pert'., Galium, Sarsap., Silic, Zincum. 

Pyelitis, Inflammation of the Renal Pelvis. 

In the catarrhal form the blood-vessels of the mucosa are dis- 
tended, and the surface of the mucous membrane is covered with 
mucus or a muco-purulent secretion. In the diphtheritic form we 
find upon the mucous membrane yellow spots, which consist of 
mortified tissue. 

In the calculous form stony concrements are always present. 

Pyelitis may be excited by the abuse of balsam of copaiva. cu- 



PYELITIS. 077 

bebs, turpentine, cantharides ; by catcbing cold ; by the presence 
of urinary eoncrements, animal parasites; by the ammoniacal 
decomposition of the urine ; in women after obstetrical opera- 
tions, in the puerperal stage, and during pregnancy ; by inflam- 
mation of neighboring parts ; and it is often a complication of 
typhus, typhoid, and exanthematic fevers, of diphtheria, cholera, 
carbuncle, and scurvy. 

It usually runs a latent course, when it is the accompaniment 
of some severe constitutional affection. In the catarrhal form 
the urine is always acid, often contains some blood, mucus and 
pus, and at times epithelial cells of the renal pelves. A sense of 
weight or pain in the region of the kidneys, extending downward 
to the bladder, slight febrile movements and digestive disturb- 
ances are often, but not always present. 

When it is caused by ammoniacal decomposition of the urine, 
it is always a complication of some other chronic disease, stric- 
tures, hypertrophy of the prostata, catarrh of the bladder, spinal 
diseases, etc., which cause a retention of urine. Its symptoms 
are finally those of uraemia. 

The inflammation of the renal pelvis sometimes extends to the 
parenchyma of the kidneys, when it is called Pyelonephritis. 

The most characteristic symptom of pyelitis is the presence of 
epithelial cells of the renal pelvis in the purulent urine. But these 
are not always found and the maladies which accompany pyeli- 
tis are often of so grave a nature that the morbid manifestation 
in the kidneys is altogether overlooked. 

THERAPEUTIC HINTS.— Pwndeni sediment, Canthar., Merc.corr., 
Nux vom., Petrol., Phosphor., Pulsat., Sepia, Sulphur. 

Gravel in the urine, Lycop., Sarsap. Compare the preceding 
chapter. 

Perinephritis, Paranephritis, Inflammation of the Renal 
Capsule. 

The capsule appears injected and infiltrated with exudation, 
or covered with purulent secretion, in consequence of which, ad- 
hesions are formed with neighboring organs. It may lead to a 
thickening of the capsule, or to the formation of abscesses. 

Primarily, it is caused by external injuries, and exposure to 
cold. 



678 KIDNEYS. 

Secondarily, it may be a continuation of an inflammatory pro- 
cess in its vicinity, or of pyaemia. 

Its Symptoms very much resemble those of other inflammatory 
affections of the kidneys. There are rigors, followed by fever, 
and a temperature usually reaching 103^° F. ; there is a dull 
and often acute pain in. the region of the kidney or kidneys; 
there is constant desire to urinate, with but little discharge ; the 
urine is highly colored and hot, but contains no blood, thus dif- 
fering from nephritis, nor purulent sediments, thus differing from 
pyelitis. There is vomiting, and when an abscess is formed, the 
pus discharges either into the peritoneal cavity, or, in conse- 
quence of adhesion, gradually burrows downwards in different 
directions between the different fascias, or works towards the sur- 
face and breaks through in the lumbar region. In the latter 
case Ave observe a gradual increasing swelling in the renal region, 
which fluctuates, points and bursts. 

THERAPEUTIC HINTS.— Aeon., Arnica, Bellad., after exposure 
to cold or external injury; Hepar, Mercur., Silic, for abscess. 

Morbus Addisonii. 

Quite a number of well observed cases have been recorded, in 
which the symptoms of this disease have been found in connec- 
tion with disease of the supra-renal capsules, so that the probability 
of a relation of cause and effect between the two becomes almost 
a certainty. The morbid changes found in the supra-renal cap- 
sules consist of a proliferation of small cells in consequence of 
chronic inflammation and a final breaking down of the structure 
into caseous masses of various sizes. In this way gradually every 
trace of proper tissue disappears and we have nothing left but a 
firm caseous mass, which has grown from the middle of the 
medullary portion towards the surface. There also have been 
observed in many cases of undoubted Addison's disease haemor- 
rhages into the tissue of these bodies, which may be so severe as 
to swell one of them up into a tumor the size of a child's closed 
fist; less frequently new formations are found, comprising carci- 
noma, sarcoma and echinococcus. 

The changes met with in the sympathetic nervous system, such as: 
deposition of pigment in ganglion cells, fatty degeneration, pro- 
liferation of the connective tissue, excessive hyperemia and dila- 



MORBUS ADDISONII. G79 

tation of the vessels, are changes which also have been observed 
in connection with other pathological processes. 

Symptoms. — Among the first signs of the disease which the 
patient can recall after ailing for months and longer, are great 
weaarmess throughout the body, and tearing, dragging pains in both 
hypochondria (frequently more intense in the right), along the 
back, in the sacrum and especially in the joints, which latter 
resemble most closely the arthritic neuroses of hysterical indi- 
viduals and which might be mistaken for acute rheumatism, if it 
were not for the absence of any swelling or alteration in the shape 
of the joints. With these are associated dyspeptic symptoms, 
such as cardialgia, eructations, loss of appetite, nausea, vomiting 
and distention of the stomach and abdomen. The fat of the body 
is at first well preserved, but the loss of muscular power is appa- 
rent very early, manifesting itself by a slight tremor of the hands, 
an inability to squeeze tightly and a tiredness after very little 
exertion. These symptoms may be considered as the prodromal 
stage. 

Further on we observe an exceedingly soft, small, weak and 
generally rapid pulse, weak cardiac impulse and a want of sharpness, 
or of even faint casual murmurs here and there, in the case of all 
the valves as also of the larger vessels. Resulting from this there 
is a remarkable paleness of the skin, sometimes amounting to 
cyanosis, a somewhat quickened respiration and a temperature 
generally somewhat below the normal. The dyspeptic symptoms 
increase and an alternate constipation and diarrhoea is often 
present. The urine remains normal. Along with these symptoms, 
a more or less distinctly marked discoloration of the skin gradu- 
ally develops, commencing as a light dusky gray and passing on 
to dark brown, first on the hands and face, either as a mottling, 
or diffusely, or occasionally in streaks. The areola of the breast, 
the genitals and the folds of the axilla color most intensely. On 
the mucous membrane of the lips and cheeks, irregular bluish 
or blackish spots occur ; the sclerotic, the nails, the palms of the 
hands and the soles of the feet, however, remain perfectly clear. 
With this associates quickly or more slowly an intense ansemia 
and debility, painful deglutition, profuse diarrhoea and vomiting, 
headache, dulness of the sensorium, difficulty in collecting his 
thoughts, weakness of memory and actual fainting fits, and epileptic 
seizures. Meanwhile the discoloration of the skin attains to an 
intensely dark bronze-color, through all the shades from an ashy 



680 BLADDEB. 

gray, darkly icteric, mulatto and even copper-color, while the 
sclerotics still remain strikingly white. 

There are cases in which the symptoms run a more acute and 
tumultuous course, when the patient after ailing for sometime is 
suddenly confined to bed with great prostration, trembling of 
limbs on being raised, confusion of mind, dry tongue and lips, 
covered with sordes, a frequent and small pulse, and a tempera- 
ture of 104° F., similating precisely a case of enteric fever if it 
were not for the absence of rose-spots and enlargement of the 
spleen. 

Pulmonary consumption is the most frequent complication, which 
mixes itself up with the peculiar characteristics of Addison's 
disease, that we are often induced to look upon the double set of 
symptoms as almost inseparable. 

The Pbognosis is thus far considered fatal. "We have not, to 
my knowledge, an authenticated case of this disease cured in our 
literature. 

THERAPEUTIC HINTS.— J. Payr recommends: Bellad., Natr. miir., 
Iodium, 01. jec. asel., Cinchona, Ferrum, Phosphor., Cuprum, Lycop., 
Carb. veg., Arg. nitr., Ars. by dr. 

Hughes mentions: Arsen., Calc. ars., Kreosot. 

Lilienthal refers to: Psorin., Therid., according to Baruch, and 
Natr. sulph., to which I may add Kali carb., on account of the 
paretic effects upon the heart-muscle of potassa salts; Sepia and 
Sulphur., especially for the earlier stage. 

A. Rockwell has seen beneficial effects from the application of 
the Faraday current. 



DISEASES OF THE BLADDER. 
Cystitis, Inflammation of the Bladder. 

As the walls of the bladder consist of a mucous lining inte- 
riorly, a muscular coat exteriorly which is partly covered by the 
peritoneum, and connective tissue between them, it is clear that 
an inflammatory process may have its seat more or less exclu- 
sively in any of these tissues, or involve the whole structure. 
Books speak therefore of: 

Cystitis catarrJialis, when the mucous membrane: of 

Cystitis submucosa, when the submucous connective tissue: of 



CYSTITIS. 681 

Cystitis subserosa, when the subserous connective tissue; of 
PerycystUis or Paracystitis, when the peritoneal covering; and of 
Cystitis parenchymatosa, when the whole structure is the prin- 
cipal seat of the inflammatory process. But these forms are 
always more or less mixed up with one another. 

The catarrhal form, when recent, is characterized by congestion 
of, and mucous secretion from, the mucous membrane, when 
chronic, by a livid appearance of the membrane, and slate colored 
spots on it ; the membrane itself gradually disorganizes, is found 
softened, thickened, infiltrated, and covered with a thick, grayish, 
purulent secretion, which by decomposition makes the urine am- 
moniacal. The inflammation rarely stays confined to the mu- 
cosa, but spreads to the submucous connective tissue, causing the 
formation of abscesses, or involves the muscularis inducing hy- 
pertrophy of the same. In this way the walls of the bladder may 
attain great thickness ; the bladder ma} T enlarge in size generally, 
reaching often as high up as the navel (eccentric hypertrophy) ; 
or its size may shrink down to that of a walnut (concentric hy- 
pertrophy). Sometimes, when the bladder is capacious, the mus- 
cular bundles are pushed asunder and the mucous membrane 
prolapses between them, and becoming in time more and more 
distended by urine, forms divertkies of the bladder, which by de- 
grees may attain the size of a fist and over. As the urine con- 
tained therein is scarcely ever completely evacuated, these diver- 
ticles of the bladder form exceedingly fit places for the retention 
of concrements and the consequent formation of stones. 

The abscesses which form in the connective tissues may burst 
internally, and before bursting, if they be situated in the posterior 
or lateral walls of the bladder, may by their bulging into the 
bladder greatly obstruct the flow of urine from the ureters and 
cause regurgitation of the urine to the kidneys, or if situated in 
the neighborhood of the neck of the bladder, may lead to com- 
plete retention of urine. An abscess may also burst externally, 
either into the peritoneum with rapidly folloAving peritonitis, or 
into the cellular tissue surrounding the bladder, giving rise to 
infiltration of urine, inflammation, intense congestion, cedema- 
tous swelling of the ano-perineal region, perforation of this region, 
or the rectum or vagina, and escape of urine through the fistu- 
lous openings subsequently remaining. In other cases fistulee 
may form at the side of the pubic symphisis. 

Cystitis may be caused by exposure to cold and wet, by exter- 



682 BLADDER. 

nal injuries, by irritating drugs (cantharides, copaiva balsam, 
etc.), either administered internally or injected, by calculi, by 
retention of urine, by extension of inflammatory processes in 
neighboring organs (diseases of the prostata, strictures and in- 
flammation of the urethra, etc.), by infectious diseases. 

Symptoms. — The acute form is characterized by severe pain in 
the region of the bladder, which is worse from external pressure 
and motion, and frequently extends along the ureters upwards 
into the kidneys, or downwards through .the urethra, by frequent 
painful micturition and strangury. The urine is voided drop by 
drop, under great straining, and a feeling of scalding; it is highly 
colored, hot, and occasionally mixed with blood, mucus and pus. 
By fever, associated with a temperature of 100.4° to 102.2° F., 
vomiting, prostration, cold perspiration, singultus, etc., in severe cases. 

The chronic form is not so acutely painful, but always attended 
with frequent urging to micturate, and the passing of turbid 
urine which, after standing, yields a heavy, thick, glairy, viscid 
sediment of muco-purulent matter, which, on being poured from 
one vessel into another, falls out as a ropy mass. The specific 
gravity of the urine is not remarkably increased ; its reaction is 
at times slightly acid, at other times neutral, or alkaline; its 
smell is often offensive, ammoniacal. The chronic form is sub- 
jected to frequent acute exacerbations from any irritating cause, 
and is generally found in advanced age. Its Prognosis, if once 
advanced to a high degree of disorganization of the bladder, is 
very doubtful. 

THERAPEUTIC HINTS.— The most infamous practice is the ad- 
ministration of morphine, which not only gives no real relief, 
but destroys all chances of recovery by paralyzing the whole ner- 
vous system. 

High fever; restlessness; constant urging, yet fearful of void- 
ing the urine on account of the painfulness of the act, Aeon., 
Bellad. 

Violent burning in bladder, Aeon., Arsen. 

Burning and pressure in bladder, Nnx vom. 

Violent tenesmus and burning, Canthar. 

Bladder largely distended, Arsen. 

Congestion of the head; tongue red and dry, Aeon. 

If attended with vomiting, cold perspiration and axiety. Arsen. 

Vomiting and nausea, Canthar. ; great thirst, Arsen., Canthar. 



CYSTITIS. 683 

Frequent small pulse, Canthar. 

After a fall, blow, etc., Arnica. 

After taking cold, Mercur., Pulsat. 

After irritating drugs, Camphora. 

In chronic cases, Calc. carb., Carb. veg., Coloc, Dulcam., Lycop., 
Phosphor., Petrol., Sulphur, Sarsap., Uva ursi. 

Aeon., in all acute catarrhs, characterized by high fever, rest- 
lessness, and brought on by exposure to cold, dry winds. The 
urine is scalding hot, dark red or turbid; micturition painful, 
difficult, sometimes only drop by drop; children reach with their 
hands to the genitals and cry out. 

Apis, urine scanty, smoky, bloody; if caused by cantharides. 

Arsen., burning pain, especially at the commencement of urinat- 
ing; fever; great restlessness ; cold perspiration; face and extrem- 
ities cold; or in chronic cases with inability to void the water; 
bladder greatly distended and paralyzed; urine turbid, mixed 
with pus and blood. 

Bellad., if not better some twelve hours after Aeon. ; rapid sink- 
ing of strength ; the region of the bladder is very sensitive to the 
touch ; the urine hot and fiery-red, clear at first, but soon becom- 
ing turbid on standing, and depositing a copious, slimy, bright 
red, bran-like sediment. 

Berber., stitching, recurring, crampy pain ; constrictive pain in 
bladder ; thick mucous and bright red, mealy sediment. 

Camphora, if caused by cantharides, balsam of copaiva, turpen- 
tine, etc. ; after measles. 

Cannab., if not better after Canthar. within about twelve hours ; 
gonorrhceal inflammation; urine loaded with mucus. 

Canthar., spasmodic pain in the perinseum along the urethra 
down into the testes, which are drawn up; intolerable burning 
pain in the bladder; cramping pain in the thighs; cutting 
through the abdomen; burning pain in the glans penis, the 
orifice of which is reddened; micturition difficult, only drop by 
drop, with a feeling as though melted lead were passing through 
the urethra, with violent straining, which increases the pain ; 
urine at first clear, but afterwards turbid, bloody, scanty, or only 
blood; painful erections of the penis; great restlessness and 
fever ; thirst, but drinking or even the sight of water increases 
the pain. 

Carb. veg., in old people and chronic cases where the acute in- 
flammation has subsided and only blenorrhcea exists. 



684: BLADDER. 

Caustic, when in consequence of long retention of urine the 
musular coat becomes paralyzed ; compare Helleb., Hyosc, Arsen., 
Gelsem. 

ChimapL, urging to urinate after micturition; the urine is high- 
colored, depositing a copious, mucous sediment; constipation. 

Coloc, after alleviation of the most violent symptoms, when the 
pain during micturition extends all over the abdomen, and the 
urine looks turbid when first voided, depositing, on standing, a 
tough, mucous sediment, which can be drawn into strings. 

Copaiva balsam, swelling and dilatation of orifice of urethra. 

Dulcam., in chronic cases, with constant desire to urinate, deep 
in the abdomen; urine is limpid when voided, but assumes an 
oily consistence on cooling, and contains a tough, jelly-like, whit- 
ish, or reddish mucus, intermixed with little lumps of blood; it 
smells foul. All symptoms grow worse when the weather changes 
from warm to cold. 

Elater., constant heat at neck of bladder, with extremely pain- 
ful micturition, inducing even convulsions. 

Gelsem., detrusor and sphincter muscles paralyzed; bladder 
distended; urine constantly drippling off involuntarily; not a 
drop by straining; no pain. 

Helleb., the inflammatory process increases slowly to the greatest 
violence, with constant desire to urinate, causing spasms; little 
urine is voided; constant nausea: distended abdomen. 

Hydrasi, thick, ropy mucus and bloody sediment. 

Hyosc, retention of urine, so that the bladder becomes largely 
distended; urine turbid, depositing a mucous or purulent sedi- 
ment; great thirst; dry tongue ; delirium; subsultus tendinum. 

Kali bichr., urine alkaline and ropy. 

Laches., discharge of bad-looking mucus during micturition ; 
dull pain in the bladder; sensation as if a ball were rolling in 
the bladder. 

Lycop., dull, pressing pain in the region of the bladder and ab- 
domen; the urine is turbid, milky, depositing a thick, purulent 
sediment of a most nauseating smell ; chronic cases : disposition 
to urinary concretions. 

Mereur., fever with chilliness ; great soreness in the region of 
the bladder when touching it ; violent urging ; the urine flows 
in a thin stream, or only drop by drop : contains mucus, blood, 
even pus ; during micturition sweat breaks forth ; gonorrhceal 
inflammation. 



CYSTITIS. G85 

Natr. mm\, pain is greatest after micturition. 

Nux vom., painful, ineffectual desire to urinate, or discharge of 
urine drop by drop, with burning and tearing; pale urine fol- 
lowed by thick, whitish, purulent matter, with violent, burning 
pain ; spasmodic retention of urine ; constipation, with ineffectual 
urging ; after drugs, or suppressed gonorrhoea. 

Pareira brava, constant urging to urinate, with violent pain in 
the glans penis and straining; the pain is so great that it extorts 
loud screams from the patient; always worse after midnight till 
morning ; the urine has a strong ammoniacal smell, and contains 
large quantities of thick, tough mucus. 

Phosph. ac, when the urine looks like milk, and quickly becomes 
decomposed. 

Popul, chronic catarrh ; chronic gleet ; elderly persons. 

Pulsat, after exposure to cold, the urine deposits a slimy sedi- 
ment, which sticks to the vessel; tenesmus and stinging in the 
neck of the bladder ; the pain continuing a while after micturi- 
tion. 

Senega, urging and scalding before and after micturition; urine 
loaded with mucous shreds. 

Sepia, in chronic cases ; distention of the lower portion of the 
abdomen ; annoying, itching sensation in the region of the blad- 
der, with urging to urinate, especially in the night ; the urine 
does not flow until sitting on the vessel for some time; during 
and after micturition chilliness and heat in the head; the dis- 
charge of mucus does not take place at each evacuation of urine, 
but comes on periodically; sometimes pieces of coagulated mucus 
clog up the urethra; admixture of a kind of dark brown pigment; 
constipation. 

Sulphur, constant desire to urinate, day and night; the urine 
drops slowly out of the urethra ; it deposits thick, tough mucus, 
which sticks to the bottom of the vessel ; purulent sediment ; 
after micturition, the pain continues in the urethra until a new 
urging ensues; stools likewise painful; feverish and sleepless 
through the night; cutaneous eruptions here and there on the 
body; suppressed itch; gonorrhceal discharges; ha?morrhoidal 
disposition. 

Tereb., sensitiveness of hypogastrium ; tenesmus of bladder ; 
strangury ; burning in region of kidneys ; urine deposits a slimy, 
thick, muddy sediment. After drinking cold water while being 
heated. 



Uva ursi, frequent urging with little discharge, and a burning, 
cutting pain afterwards ; the urine is yellow, but deposits a tough 
mucus; sometimes blood and mucus are voided at the same time 
with great straining ; severe spasm of bladder before micturition ; 
at all times burning and tearing pain in region of bladder ; con- 
stipation. 

A number of other remedies may present themselves for con- 
sideration : Cale. carb., Capsic, Conium, Eriger., Graphit., Hepar, 
Nitr. ac, Phosphor., Sarsap. 

Compare also the remedies mentioned under the head of 
Kidney Diseases. 

Calculi Vesicae^ Stones in the Bladder. 

Calculi vary from the size of gravel to conglomerations of the 
size of a man's fist, and even larger. In shape they are either 
round, or flat, or rough, irregularly shaped. 

In regard to their chemical composition, they consist either of 
crystals of clear uric acid, or a combination of uric acid and 
ammonia, soda, magnesia or lime. These are hard, heavy, 
brown, yellow, or grayish -white, and are mostlj- smooth, round- 
ish, rarely irregular in shape. 

Next in frequency are those which consist of phosphates. They 
are not so compact, but are brittle, crumbly and light, of a 
whitish, grayish, seldom yellowish color, and of a roundish shape, 
with a smooth but sandy surface. 

Still rarer are those which consist of oxalate of lime. They are 
the hardest and heaviest of all, have a dark brown or blackish 
appearance, an uneven, wart-like surface and are therefore called 
mulberry stones. 

Conglomerates which consist of carbonate of lime, or cystine, or 
xanthoxyde are of very rare occurrence, while mixture* of urates 
and phosphates are quite frequently found. They generally present 
a striated appearance, or the one material forms nucleus and the 
other the periphery. 

Such urinary concretions may be very numerous. Liston 
extracted five hundred from one bladder. They are usually 
formed in the renal pelvis, and work their way gradually through 
the ureters into the bladder, where they remain and increase in 
size. Stones which are formed primarily in the bladder are 
generally solitary. They are either movable in the bladder, or 



CALCULI VESICAE. 687 

they are entangled between the folds of its mucous membrane, or 
they have formed by their weight an extension of the bladder, 
where they are held stationary, or they have originated in a 
divertiele of the bladder. 

Those which roll about freely in the bladder are always of a 
roundish shape and smooth, while those which are stationary 
assume an uneven and jagged surface. Very large stones nearly 
fill the cavity of the bladder; they have been found to weigh from 
five to six pounds. 

Gravel passes away without much difficulty. Neither do smooth 
and movable stones, if not too large, cause much inconvenience. 
But when they are of larger size, and of a rough and irregular 
shape, they cause considerable trouble. 

Symptoms. — 1. In rare cases the patient feels a heavy body in the 
bladder moving about tuhen changing position. 

2. Pain in the neck of the bladder when walking, standing, 
sitting or during stool; still worse when riding in a carriage or 
on horseback, but much less during rest, and especially while 
lying on the back or on the face. This symptom becomes quite 
characteristic when, after riding in a carriage or on horseback, 
there follows — 

3. A discharge of bloody urine and an increase of catarrhal 
inflammation of the bladder. 

4. Sometimes the pain is not felt in the bladder at all, but in 
the glans penis and along the urethra, which constantly tempts the 
patient to squeeze and pull at the penis. This constant irritation 
may lead boys to the habit of masturbation and the frequently 
repeated pulling may produce an elongation of the penis and 
hypertrophy of the prepuce. 

5. Strangury commences when the last drops of urine are 
voided and continues for a while afterwards. 

6. Sudden stoppage in the flow of urine (although the bladder be 
not emptied) by the rolling of a calculus before the opening of 
the bladder. In other positions, especially that of lying on the 
back, the urine flows again. 

7. Sometimes a distinct feeling, as though something were 
wedged into the neck of the bladder, causing difficulty in mak- 
ing water, when a calculus has been driven into the opening at 
the neck of the bladder. 

8. Reflected pains, as spasms in the rectum, vagina, testicles, 
kidneys, perinseum, legs, etc. 



9. In rare cases, when there are many stones in the bladder, on 
succussion of the body they may even be heard and felt rattling 
in the bladder. 

10. Examination by the metallic sound reveals a hard body, 
which, on being struck, gives a metallic sound. 

THERAPEUTIC HINTS.— Large stones, it is true, cannot be dis- 
solved again, but belong into the domain of surgery. But it is a 
question whether Ave cannot do something to prevent their forma- 
tion. According to our records a number of remedies have shown 
themselves efficacious in expelling gravel and in restoring a 
normal secretion of urine. If such be the case, is it not equal to 
preventing larger conglomerations? and is not one pound of 
prevention worth more than ten pounds of cure? 

Moreover it is true that all who suffer with gravel need not 
necessarily become affected with stone in the bladder; just as 
every one who falls need not necessarily break his neck. But 
who can tell beforehand the result in either case? The remedies, 
after the use of which gravel and small stones have been observed 
to be discharged, are: Aspar., Berber., Calc. carb., Calc. urinaria, 
Cannab., Ipom. (Jeanes), Lycop., Lyth. carb., Nitr. ac, Nux vom., 
Petrol., Phosphor., Pulsat, Sarsap.. Sulphur, Tabac., Uva ursi. 

Among the new remedies are mentioned, Aln. rub., Chimaph., 
Collin., Corydal., Eriger., Eryng., Eupat. arom. and perf, Frasera, 
Galium, Gossyp., Podoph. 

For particulars, study Lythiasis Renalis, Catarrh of the Blad- 
der and the Materia Medica. 



Hyperesthesia or Irritability of the Bladder; Spasm of 
the Bladder. 



shows itself as an increasing intolerance, espe- 
cially of the neck of the bladder, for the normal irritation of the 
urine, so that even a small quantity of urine excites a more or 
less painful urging to pass water. Such a condition may often 
be traced to a rapid fall of temperature, or to too often repeated 
sexual indulgence. 

Spasm of the sphincter is much severer: it is attended with 
strangury, that not a drop of urine is allowed to escape: or if by 
reflex action, the detrusor urinae be alternately irritated, the urine 
is squirted out in jerks, with frequent interruptions, or pa<ses 



PARALYSIS OF BLADDER. 689 

slowly, drop by drop, with much trouble and pain. It is often 
attended with neuralgic pains in the hypogastrium and in the 
ano-perineal region, which may spread to the urethra, glans, 
testes, clitoris, thighs, loins and inguinal region, and upwards to 
the epigastrium and lowest ribs. These vesical spasms may 
occur at each attempt to pass water, or only occasionally ; some- 
times the urine escapes involuntarily. The paroxysms may last 
from a few minutes to half an hour or more, and usually sub- 
side when the urine flows ; when very severe, they may be ac- 
companied by great excitement, anxiety, nausea, vomiting, clonic 
convulsions, small pulse and cold perspiration. In uncompli- 
cated cases the urine is usually of a normal condition, at times 
remarkably pale, like urine in spasmodic affections generally. 

Spasm of the bladder occurs in children and adults, and may 
be caused by mental excitement, excessive sexual indulgence, 
onanism; drugs, sour wine, young beer, sitting on damp and 
cold ground; they may be connected with diseases of the rectum, 
such as fistulse, fissures, ulcers, haemorrhoids, etc., or with other 
neuralgic affections and various cerebro- spinal diseases. 

THERAPEUTIC HINTS.— The irritability of the bladder is fre- 
quently met by: 

Arnica, feeling of great fulness of the bladder. 

Bryon., worse from moving. 

Colonic,, gouty diathesis. 

Ferr. phosph., worse in daytime. 

Nux vom., after taking cold. 

Ox. ac, worse when thinking of it. 

Rhus tox., worse in the night and when at rest. 

Sabina, gouty diathesis. 

Sulphur, irresistible desire to urinate on seeing water running 
from the hydrant, similar to Canthar. and Lyssin. 

Spasms of the bladder principally: Bellad., Hyosc, Nux vom., 
Opium, Pulsat., Rhus tox., Ruta, Sulphur. Other remedies will be 
suggested by the causes and connections of this trouble. 

Atony, Paresis, Paralysis of the Bladder. 

The detrusor urinse loses its power to contract, and in conse- 
quence the urine is only partially or not at all expelled. This 
causes great distention of the bladder. The patient complains 
44 



G90 BLADDER. 

that he can only make water slowly; the desire to pass water be- 
comes less frequent, is felt only when the bladder is greatly dis- 
tended, and then only for a short time, if not soon attended to. 
The stream of the water grows feebler, is frequently interrupted, 
and at last voluntary efforts are unavailing, but the presence of 
the accumulated mass of urine becomes so great that the sphinc- 
ter yields and the urine escapes in drops involuntarily, and has a 
disagreeable ammoniacal odor. By and by the paralysis also ex- 
tends to the sphincter, and now the urine flows away uninterrupt- 
edly, which constitutes true Incontinentia urinae. But even in 
these cases the bladder is never fully emptied, and it occasion- 
ally happens that, in consequence of this prolonged retention of 
urine, ursemic symptoms supervene. 

The Diagnosis is readily made out by percussing the region of 
the bladder, which will be found greatly distended, and by intro- 
ducing the catheter, which will drain off immense quantities of 
urine. 

Paralysis of the bladder is found in diseases of the brain and 
spinal cord, in typhoid fever, in consequence of the bad habit of 
suppressing urgent calls to urinate, in old age, in diseases of the 
prostate, after injuries to the bladder or urethra, or spine. 

THERAPEUTIC HINTS.— Care should be taken to drain off, by 
the catheter, the accumulated urine in time, and, if possible, at 
regular hours. 

Arnica, feeling of fulness of the bladder with urging and im- 
possibility to void urine. (Aegidi.) 

Arsen., urging in the bladder and bowels without success; great 
anxiety and restlessness; after taking cold. (Gauwerky.) Paraly- 
sis of bladder in old people. (Krummacher.) 

Canthar., after having retained the urine too long voluntarily. 

Caustic, from long retention of urine. 

Cicuta, paralysis of the bladder with great anxiety about it. 

Gelsem., constant dribbling of urine, but not a drop flows on 
making the greatest effort; bladder distended up to the navel- 
no pain, not even on pressure. 

Helleb., paralysis of the detrusor; oedema of the legs; vomiting 
of all he eats; constipation; sleeplessness; despair of getting well. 
(Mossbauer.) 

Hyosc, after labor, and in children with affections of the head. 
(Small.) 



ENURESIS NOCTURNA. 691 

Iodium, incontinence of urine in the aged. 

Nux mosch., hysteria with strangury. 

Nux vom., after catching cold ; after sexual excesses. 

Opium, retention of stool and urine. 

Phosphor., in spinal troubles. 

Staphis., involuntary discharge of urine, acrid and corroding, 
with burning; worse from motion ; constipation; straining or ex- 
ternal pressure causes no discharge; after difficult confinement. 
(Win. Gross.) 

Compare also: Bar. carb., Bellad., China, Ignat., Lycop., Natr. 
mur., Phosphor., Podoph., Rhus tox., Ruta. 

Enuresis Nocturna. 

Wetting the bed may be a bad habit with some children, or 
the consequence of their sleeping too soundly, but in most cases 
it depends upon a local atony associated with increased sensitive- 
ness of the neck of the bladder. It is more frequently found in 
boys than in girls, and it ceases on the average about the tenth 
or twelfth year, latest at puberty. 

THERAPEUTIC HINTS.— Rough and harsh treatment will be of 
no avail. 

Amm. carb., enuresis occurring at any time at night; pale 
urine ; red sediment. (Greeley.) 

Arg. nitr., incontinence of urine during the day. 

Bellad., starting in sleep; moaning and screaming during sleep; 
scrofulous glandular swellings. 

Benz. ac, when the urine has a very penetrating smell. 

Calc. carb., scrofulous children, who sweat and catch cold easily. 

Caustic, enuresis during first sleep ; chronic, periodic swelling 
of the tonsils ; sequelae of itch ; sweat on genitals ; green halo 
around the candle-flame. (Wm. Gross.) Blepharitis ciliaris of 
herpetic nature. (Goullon.) 

Chamom., child cross, has to be carried ; whooping cough as a 
complication. (Miller.) 

Chloral, enuresis in the latter part of the night, even if they 
have urinated during the night and drank no water. (Oehme.) 

Cina, urine profuse and of strong ammoniacal odor ; great ap- 
petite soon after leaving the table. (0. M. Pierson.) 

Equisetum, when there is no tangible cause except a habit. 

Ferr. met, when the child presents an anaemic appearance with 



692 BLADDER. 

pale face which flushes easily from excitement or pain. (Hering.) 
Frequent wetting the clothes during the day. 

Ferr. phosph., similar. 

Kreosot, when it is very difficult to waken the child out of sleep. 
(Boenninghausen.) 

Plantago, copious enuresis ; atony of the sphincter. 

Sepia, follows well after Caustic. ; same symptoms. 

Silic, complication with worms or chorea. 

Sulphur, diagreeable sensation of hunger with flushes of heat 
about 11 a.m. (Goodno.) Pale, lean children with large abdo- 
men, who love sugar and highly seasoned food, and abhor to be 
washed. 

Thuja, when the urine is highly colored and of a strong smell ; 
warts here and there. (Linsley.) 



ORGANS OF GENERATION 

MALE GENITALS. 



VENEREAL DISEASES. 



We understand by this term all those morbid affections of the 
genitals in particular, and of the whole system in general, which 
originate ex usu veneris in consequence of the absorption of a spe- 
cific poison. The nature of this poison is as little known as that 
of small-pox, or of scarlet fever and measles ; only that it is not 
volatile, but fixed to the morbid secretion. As to the rest, like 
either of them, it produces, when introduced into a healthy or- 
ganism, a certain series of symptoms specific in their nature, by 
which process the same virus is produced anew, capable of fur- 
ther propagation. The principal forms caused by this specific 
contagion are : gonorrhoea, chancre, and constitutional syphilis in all 
its various forms. 

It lies entirely beyond the limits of this work to go into any 
details in regard to the different views about the identity or non- 
identity of the venereal virus and its effects, as have been set 
forth in the last fifteen years by a number of renowned syphilo- 
dologists. Their works alone would make up a small library. 
I shall merely give what seems to be the result of these contro- 
versies adopted by the majority at present. 

Gonorrhoea. 

We understand by it a virulent catarrh of the genital organs, 
which in appearance is entirely analogous to any other catarrhal 
inflammation of any of the mucous membranes ; but which en- 



694 MALE GENITALS. 

tirely differs from all the others by being the result of a specific 
virus, acquired during coition with an individual thus affected. 

Its seat is usually the fossa navicularis, and that portion of the 
urethra which lies back of the glans ; sometimes, however, the 
inflammation extends further back to the bulbus, the membra- 
nous portion of the urethra, and even to the neck of the bladder. 

In women the inflammation and secretion extend over the vulva, 
vagina and urethra, sometimes spreading even into the womb. 

Symptoms. — The first symptoms generally appear from one to 
two, rarely from six to eight days or more, after the infection. 
They consist of a tickling sensation at the orifice of the urethra 
and in the fossa navicularis. Soon there is an increased secretion 
of mucus in the urethra, which pastes the lips of the orifice to- 
gether ; the tickling changes into burning, and the mucus, at first 
transparent, becomes thick, whitish, yellowish, greenish, or even 
bloody, and more or less profuse. The orifice of the urethra is 
inflamed and swollen ; a tensive pain extends all along the urethra 
into the testicles and inguinal regions ; micturition is very pain- 
ful and frequent. 

In some cases, the so-called synochal or phlegmonous gonorrhoea, 
the inflammation extends into the parenchyma of the glans, 
which appears darkened and swollen ; and into the corpus caver- 
nosum, with exudation, which forms hard places in the penis. 
This gives rise to the so-called Chordee, by which, during erec- 
tions, the penis is bent either downwards or sideways. The 
urine can be passed only drop by drop, with the most intense 
pain and great straining. The discharge becomes still more dis- 
colored — dark or bloody, even ichorous ; or it is not discharged 
at all, on account of the high state of inflammation. The pre- 
puce is contracted, and cannot be brought back over the glans — 
Phimosis; or it is contracted behind the glans, and cannot be 
brought forward — Paraphimosis. 

The inflammation spreads even to the neck of the bladder and 
the neighboring areolar tissue, in consequence of which abscesses 
may form and break through the perineum, giving rise to fistula 
urinse. 

Other cases, the so-called indolent or torpid gonorrhoea, are at- 
tended with very little pain ; and the only symptom which is of 
any inconvenience to the patient is a more or less profuse mucous 
discharge. This indolent form is usually found in persons who 
have had the disease several times. It seems, that the system 



GONORRHCEA. G95 

gets accustomed even to the most violent poisons, as may be seen 
in prostitutes. Yet, innocent as it seems, it is generally very ob- 
stinate, and is apt to become chronic ; and if transferred to other 
persons not quite so hardened, it may cause the most virulent 
symptoms. In still other cases — the so-called erysipelatous gonor- 
rhoeas — the glans and prepuce are cedematously swollen and in- 
flamed, as in erysipelas. The pain is not so great as in the syn- 
ochal form, and the discharge is of a more watery, ichorous 
nature. 

Mild forms of acute gonorrhoea are said to run their course in 
about five or six weeks ; but most cases assume a chronic form 
and are then called Gonorrhoea secundaria or Gleet. This form is 
usually without pain ; when there is any, it is a fixed pain in 
the fossa navicularis. The discharge is mostly watery, some- 
times thick and yellowish. Usually there is only a single drop, 
and that to be seen in the morning ; at other times the lips of 
the meatus urinarius merely stick together; sometimes, however, 
the discharge continues to be more or less profuse. This state of 
things may last, with various degrees of severity, for months, 
even years. 

In the female the symptoms of gonorrhoea ar.e nearly the same ; 
generally, however, they are less painful, because the vagina, the 
part principally affected, is wider and less sensitive than the ure- 
thra in the male. Still, in higher degrees of inflammation, and 
when extending to the female urethra, the clitoris and the labia, 
it may become quite as painful. The discharge is then quite 
profuse and discolored, excoriating the external parts. Fre- 
quently it is associated with condylomata on the inside of the 
thighs and around the anus. Excoriations and ulcers also exist 
on the neck of the uterus, and sometimes the morbid process ex- 
tends into the womb and ovaries, causing chronic catarrhal af- 
fections there. Its cause is, as stated above, an infection by a 
specific virus. 

Catarrhal inflammation of the mucous membrane of the sexual 
organs may be brought on by a variety of causes — irritation by 
foreign bodies, sexual excesses, coitus with menstruating women, 
or such women as suffer with acrid leucorrhcea. Even drinking 
new wine or sour beer may cause strangury and a gonorrhoea-like 
discharge. Such inflammations are of a much lighter nature, 
and cease in a few days without medication ; but as we cannot 
distinguish between a chronic gonorrhceal discharge and a mere 



696 MALE GENITALS. 

acrid leucorrhcea, it is very well to know that a gonorrhoea-like 
discharge may be caused by a mere acrid leucorrhcea, if for nothing 
more than to preserve the peace of a family. 

The gonorrhceal virus is transferable by the muco-purulent 
discharge of a gonorrhceal patient whenever it comes in contact 
with the mucous membrane of the urethra or vagina of a healthy 
person. None are proof against the contagion, although some 
persons are more easily infected than others; and any one who 
has once had gonorrhoea is very liable to have it again. 

THERAPEUTIC HINTS.— The number of recommended remedies 
for this complaint is great, but yet the curing of it is often a diffi- 
cult task. For its very first stage Grauvogl has recommended 
Natr. sulph.; Jahr, Sepia; Wahle, Bryon.; Baehr, Merc, sol.; 
Kafka, Sulphur; a number of others, Cannab. Schiissler: Ferr. 
phosph., later Kali mur. and Kali sulph. 

In this, as well as in all other cases, we must closely indi- 
vidualize. 

Aeon., inflammatory stage. 

Agave Americana, excruciating, painful erection ; chordee, stran- 
gury; drawing in the spermatic cords and testicles, extending to 
the thighs, so violent that he wishes to die. 

Agn. cast, gleet, yellow purulent discharge; old sinners with 
sexual inability. 

Ahun. P. S., gleet. 

Ant. crud., urine mixed with blood; suppression of urine. 

Arg. nitr., burning in the urethra during micturition, with a 
feeling as though the urethra were swollen and sore inside; the 
last portion of the urine remains in the urethra; discharge of 
blood and pus from the urethra; chordee; sensation as if the 
urethra were drawn into knots; swelling of penis; feverishness. 

Gale, carb., gleet, after Sulphur; fat, lymphatic persons. 

Camphora, sticking together of the meatus; chordee; testicles 
relaxed ; want of erections. 

Cann. ind., priapism; chordee; involuntary erections and emis- 
sions; nymphomania. 

Cann. sat., great swelling of the prepuce, approaching to phi- 
mosis; dark redness of glans and prepuce; light red spots on the 
glans, of the size of a lentil; inflammatory stage with all its 
painful symptoms, especially violent burning in the urethra 
during and after micturition. 



GONORRHOEA. 697 

Canthar., when the inflammation has spread to the bladder, 
with intense tenesmus; bloody discharge and soreness of the 
urethra during the flow of gonorrheal mucus; violent and very- 
painful erections at night. 

Capsic, white discharge like cream ; cutting, stinging pain in 
the urethra without, burning during micturition; chordee. 

Cleraat, after great straining a few drops of urine pass away, 
which is followed by a full stream without pain; after this 
sometimes dribbling of urine. 

Colonic, scanty, dark, albuminous urine; constant urging with 
burning in urethra when urinating; whitish, flocculent or puru- 
lent sediment in urine. 

Copaiva, soreness, smarting, itching and swelling of urethra; 
purulent discharge; violet smell of urine; eruption like measles, 
or urticaria with great itching. 

Cubeb., dark and reddish discharge as if mixed with blood; 
violet smell of urine; cutting and constriction after micturition. 

Doriph., glans swollen and bluish-red ; gleet. 

Ferrum, gleet, painless discharge like milk. 

Ferr. phosph., inflammatory stage. 

Fluor, ac, gleet, little discharge during the night, which makes 
a yellow stain on the linen; oily transpiration of the genitals 
with a penetrating smell. 

Gelsem., whitish discharge; severe erections; burning when 
urinating; rheumatism; orchitis. 
• Graphii, gluey, sticky discharge at the meatus urinarius. 

Hydrasl, acute and chronic form; feeling of debility and faint- 
ness after each passage from the bowels. 

Kali bichr., a drop of urine seems to remain after micturition, 
which cannot be expelled and troubles for a long time. 

Kali nmr„ gleet combined with eczema (latent or visible); or a 
disposition to glandular swellings. 

Matico, in acute and chronic forms — no particulars given. 

Mercur., when complicated with chancre ; or in gleet, after Can- 
nab., when the discharge is yellowish-green and purulent ; dis- 
charge more profuse at night than during the day. Phimosis, 
bloody pollutions. 

Mezer., gleet; hsematuria during gonorrhoea; tearing pains 
from front to back. 

Millef., swollen penis ; discharge of blood and watery slime. 

Natr. mur., after injections of nitrate of silver, in gleet ; in gon- 



698 MALE GENITALS. 

orrhoea-like discharges from acrid menstrual discharges ; cutting 
and burning after micturition. 

Nitr. ac, in complication with chancres, balanitis and fig- warts; 
small blisters on the orifice of the urethra and inner surface of the 
prepuce, forming chancre-like ulcers ; painful brown spots of the 
glans ; after mercurial treatment ; gleet ; ulcerating buboes ; con- 
dylomata. 

Nux vom., after the use of copaiva and cubebs, and after allo- 
pathic treatment; dull pain in the back part of the head; haem- 
orrhoidal disposition ; constipation ; suppressed discharge, with 
swelling of the testicles ; high living. 

Petrol., chronic cases with stricture of the urethra ; prostatitis ; 
frequent emissions and imperfect erections ; itching and humid 
eczema on scrotum, perineum, or between the scrotum and 
thighs. 

Petros., troublesome tickling and itching in the urethra, with 
constant desire to urinate, worse in the morning in bed ; better 
when sitting or standing, chronic cases ; suitable for old persons. 

Phosphor., gleet ; every morning a drop of watery fluid at the 
orifice of the urethra, sticking its lips together ; also in case of 
hypertrophy of the prostata. 

Phosph. ac, gleet ; every morning a few drops of a white dis- 
charge from the urethra, and in the evening discharge of prosta- 
tic juice. 

Pulsat, in consequence of suppression of a gonorrhceal discbarge, 
swelling of the testicles and prostate gland ; inflammation of the 
eyes. 

Sarsap., rheumatism of the joints after suppression. 

Sepia, gleet, no pain, no discharge, except through the night a 
drop or so, staining the linen yellowish ; or milky or greenish dis- 
charge, attended with pain in the back ; frequently quite import- 
ant for women. 

Sulphur, the orifice of the urethra is red and feels hot ; whitish 
discharge ; no pain or some slight burning in the urethra : rheu- 
matic pains ; chronic inflammation of the eyes ; chronic pros- 
tatic affections ; hsemorrhoidal disturbances ; psoric cutaneous 
eruptions ; gleet. 

Tarant, chronic form ; loss of memory ; timidity ; weakness : 
great nervous agitation ; burning of soles of feet and palms of 
hands; shaking, twitching and incessant movements of legs, 
worse when quiet. 



COMPLICATIONS AND SEQUELS. G99 

Tereb., chordee ; gleet; gonorrhoeal rheumatism. 

Thuja, gleet ; condylomata ; prostatic affections ; discharge, thin 
and greenish; red spots and erosions on the glans; sudden stitches 
along the urethra from back to front ; or a sensation as if a drop 
of urine were passing along the urethra with cutting pains. 

Tussil., acute stage; fixed stinging pain in the fossa navicularis; 
for persons of high living and irregular habits ; chronic stage 
with inflammation of the eyes and swelling of the testicles, after 
suppressed discharge. 

Besides these, a number of remedies are mentioned and praised 
by eclectics, (see Hale's New Remedies) but without the slightest 
characteristic indications. 



Complications and Sequelae. 

1. Epididymitis; Orchitis. 

Usually only one side is affected at a time; but the inflamma- 
tion sometimes goes also to the other. The scrotum of the af- 
fected side becomes greatly enlarged, is hard, red, shining and 
very painful to the slightest touch or move; it is usually at- 
tended with fever, and follows either upon undue exertions, tak- 
ing cold, and most frequently after the suppression of gonorrhoeal 
discharges by injections. 

Compare Agn. cast., Aurum, Bromium, Clemat.. Hamam., 
Mercur., Nitr. ac, Nux vom., Phytol., Pulsat, Rhodod., Rhus tox., 
Tussil. 

2. Prostatitis Gonorrhoea, Inflammation of the Prostata, 

Is of rare occurrence, and only in those cases in which the in- 
flammation spreads to the neck of the bladder, or in consequence 
of suppression of the discharge by injections. It is attended 
with a sensation of heat in the perineum, in the region of the 
bladder and towards the rectum, and with tenesmus in bladder 
and rectum. It may end in suppuration and the formation of 
an abscess, which may discharge its contents into the bladder or 
urethra, or through the perineum, or it may end in chronic in- 
duration of the prostatic gland. 

Compare Mercur., Nitr. ac, Phosphor., Pulsat., Selen., Sulphur, 
Thuja. 



700 . MALE GENITALS. 



3. Gonorrhoea Vesicae, 



That is, a transmission of the disease to the neck, or into the 
body of the bladder, consequent upon suppressing the discharge 
by injections. The patient feels violent pains in the region of the 
bladder, the perineum and anus, with constant urging to urinate. 
By dint of the greatest straining, a few drops only, of a turbid 
urine mixed with blood and pus, are discharged. 
Main remedy : Canthar. Compare Cystitis. 

4. Buboes. 

Inflammatory swellings of the inguinal glands, which gener- 
ally grow very slowly, and are brought on either by overexertion 
or suppression of the discharge. 

Compare Iodium, Laches., Mercur., Nitr. ac. 

5. Ophthalmia Gonorrhoica. 

One of the most dangerous inflammations of the eyes. The 
infection may be caused either by the direct contact of the poison 
with the eyes, by means of the fingers or soiled handkerchiefs, or 
by metastasis. 

Compare Aeon., Arsen., Bellad., Hepar, Merc. sol. and subl., Nitr. 
ac, Pulsat, Tussil. 

6. Gonorrhoea of the Rectum. 

Pain in the rectum; mucous membrane inflamed; sphincter 
spasmodically closed; discharge of purulent mucus mixed with 
blood. 

Compare Mercur., Nux vom., Pulsat., Sepia, Sulphur," Thuja. 

7. Strictures of the Urethra. 

They consist of a fibrous or callous hardening of certain por- 
tions of the urethra, whereby the canal becomes narrowed and 
the passage of urine difficult or altogether impossible. Their 
main seat is the membranous portion of the urethra and the fossa 
navicularis, although other parts likewise may adhere or become 
constricted in consequence of inflammation. 

The first and main symptom is difficulty in making water. 
The stream is thin, twisted, split and flows in jerks. The bladder 
cannot be fully emptied and there is a continued drihbling 
of urine for a great while after micturition. 



COMPLICATIONS AXD SEQUEL.E. 701 

They are caused frequently no doubt by the use of injections, 
mismanaged introductions of bougies, the long continuance of 
chronic gonorrhoea and excessive indulgence in sexual inter- 
course. 

Compare Clemat, Digit., Dulcam., Petrol., Pulsat., Rhus tox., 
Sulphur. 

Gradual dilatation by bougies. 

8. Gonorrheal Rheumatism. 

It is sometimes acute, attacking muscles and joints, and some- 
times chronic. It has been frequently observed to follow the use 
of copaiva balsam, or the sudden suppression of the gonorrhoeal 
discharge by other means, and after taking cold. Those of a 
rheumatic or gouty disposition are, of course, the most subject 
to it, 

Compare Hepar, Mercur., Mezer., Phytol., Sarsap., Thuja. 

9. General Contamination of the System in Consequence of 
Gonorrhoea. 

Although modern writers deny such consequences of gonor- 
rhoea upon the whole system, there is not the slightest doubt that 
a suppression of it is followed, in many cases, by severe and 
deeply-seated ailments. "We find cases on record where its sup- 
pression brought on tuberculosis; in others dyspnoea, lasting for 
many years — until, under homoeopathic treatment, an old gonor- 
rhoeal discharge suddenly appeared again and the dyspnoea dis- 
appeared. Schcenlein, Autenrieth and others acknowledge this, 
whilst Ricord denies a specific gonorrhoea-virus altogether, which 
seems to be driving the thing rather to its smallest point, on 
which it cannot stand. Grauvogl, in his Prophylaxis, gives a 
whole list of constitutional disorders growing out of gonorrhoeal 
poisoning, among which we find : glandular-like swellings upon 
the membranes of the brain, on the neck and tongue; in the 
axillee and abdomen, and its viscera; deafness; paralysis and 
mental derangement, etc. 

The most important remedies which ought to be borne in 
mind, and which cover this gonorrhoeal contamination of the sys- 
tem, as Sulphur does psoric, and Mercurius syphilitic affections, 
are, according to Grauvogl, Natr. sulph. and Thuja. 



702 MALE GENITALS. 

Balanitis, Gonorrhoea Spuria or Praeputialis. 

This affection is a profuse secretion of mucus between the glans 
and prepuce, which is formed only in men with a long foreskin. 
It is sometimes associated with genuine gonorrhoea, but may just 
as well originate from uncleanliness, friction, coitus with women 
who suffer with acrid fluor albus. In most cases it is altogether 
an innocent affair, although at times it may be of a poisonous 
nature. 

Symptoms. — Itching underneath the prepuce, which appears 
red and moist. In a few days there appear heat, pain and swell- 
ing of the prepuce, with considerable discharge of a yellowish, 
purulent mucus. Sometimes it is very difficult to push the pre- 
puce back, in which case the glans appears excoriated. If al- 
lowed to remain, ulceration and adhesion may form between the 
glans and the prepuce and cause considerable trouble. If of an 
innocent nature, it is easily managed by cleanliness and perhaps 
one dose of Mercur.; if it is in connection with gonorrhoea or 
chancre, it of course assumes the nature of its companions, and 
requires the same treatment. 

Chancre. 

The name chancre is derived from cancer, meaning a corroding 
ulcer, with hard bottom and callous edges. Its seat is at the point 
where the poison gained access, in men chiefly the glans, prepuce, 
freenum, front part of urethra, the penis externally, the scrotum, 
or the groins ; in females the labia, vagina, urethra, or the neck 
of the uterus. But the poison may also be transferred to other 
parts, such as the lips, tongue, nipples, or fingers, if through 
wounds, cracks, or denudations, it can enter into the circulation. 

There are two theories about the nature of chancre-poison. 
The one maintains that all is but one kind, which may or may 
not produce constitutional syphilis ; the other has tried to prove 
a duality of the chancre-virus, meaning that there are in reality 
two totally different kinds of sores, of which each propagates only 
its own kind. These two different kinds of chancre have become 
known under the name of soft, and indurated or Hunter's chancre. 

The soft chancre is according to this theory only a local affec- 
tion, and inoculable upon the bearer, and upon others, both 
healthy and syphilitic, to an almost unlimited extent. It de- 



CHANCRE. 703 

velops ivithout incubation in twenty-four liours. Through resorp- 
tion an irritation of the adjacent glands take place, which has an 
acute inflammatory character, and usually leads to suppuration, 
but is not followed by constitutional syphilis. The pus of the 
glandular suppuration has the same properties as the chancre 
pus. 

The hard chancre produces and is produced by true syphilitic 
poison ; it is, notwithstanding the assertions of Ricord, inocula- 
ble upon the bearer and upon others syphilitic, but produces then 
a soft chancre, to which Clerc, as Maratray had done before him,, 
gave the name of "chancroid." "Whether the poison of this chan- 
croid, when communicated to a healthy person, is capable of pro- 
ducing syphilis, or only local sores, has not been positively de- 
termined. The syphilitic poison (of a hard chancre) when inocu- 
lated upon healthy subjects, causes after a period of incuhafion of 
three to four weeks, a papule, which gradually hardens or superfi- 
cially ulcerates, or at other times immediately inflames and ul- 
cerates, as in the soft chancre, being followed later by induration 
together with general syphilis. 

The minute anatomy of chancre does not show any marked dif. 
ferences between the two ; the one thing common to both is a 
dense cellular infiltration of the tissue of the cutis or mucous 
membrane. Induration, therefore, will not hold good as a posi- 
tive distinction between the two, especially in the female genitals, 
where it may be very inconsiderable, even in so-called genuine 
hard chancres. Only if an affection is seen to begin as a papule, 
at a certain time after a possible occasion for infection, and after- 
wards gradually enlarging, it may be considered as true syphilis; 
but if, following immediately after an infection, a pustule appears, 
with subsequent ulceration, which is, perhaps, afterwards ne- 
glected by the patient, or irritated in various ways, as by im- 
proper treatment, it should be classed under the soft chancres, 
but in such cases it is often impossible to decide whether it is a 
specific induration or a mere inflammatory infiltration, because 
the beginning of it has not come under observation ; and if we 
add to this what has been stated before, that a syphilitic or so- 
called hard chancre or ulcer may originate immediately after in- 
fection like a so-called soft chancre, the diagnosis between the 
two becomes a complete conundrum. Neither hardness nor in- 
cubation prove to be entirely satisfactory. There remains only 
the subsequent development of constitutional syphilis for a dis- 



704 MALE GENITALS. 

tinction between the two ; but then the chancre has usually dis- 
appeared, and our wisdom comes post festum. In praxi then the 
so-called soft and hard chancre resemble each other frequently- 
very closely, at least while being under observation ; but even if 
we consider the theory of duality of chancre-poison as true above 
all doubt, this conviction can have no other use, than to confirm 
physicians who believe in mere local affections, in the bad prac- 
tice of cauterizing, burning and slashing away, which is not in 
accord with the spirit of homoeopathy. 

The external appearance of chancre varies. It may, as stated 
before, commence at the infected point as a papule or a pustule, 
which by degrees, enlarges, becomes harder, and at last ulcerates, 
secreting a gray, slimy pus, which adheres to the bottom. This 
sore at times remains quite superficial, at other times the middle 
of the tubercle becomes excavated, and at still other times the 
surrounding tissues become involved in a wide-spread destruction 
of tissue, when it is called phagedenic chancre. If sores form on 
the inside of the prepuce, or far back on the glans, it soon be- 
comes impossible to retract the foreskin ; the ensuing phagedenic 
process may possibly cause a destruction of the entire prepuce, 
and even of the glans, in a short time. On the mucous mem- 
brane of the female genitals chancres appear as simple erosions, 
which the patient hardly notices, with parchment-like thickening; 
real tubercular indurations are rare. From being constantly 
moistened and irritated when on the labia majora or minora, 
they are gradually transformed into moist hyperplastic growths 
— the condylomata lata. 

The syphilitic poison is contained in the primary ulcers, in the 
condylomata lata, in the blood of syphilitic persons, in the semen of 
a man with latent syphilis. Whether the milk, saliva, urine and 
perspiration of syphlitic persons be also carriers of the poison, is 
doubtful; but pathological secretions, such, for instance, as con- 
tained in the vaccine pustules, have, unfortunately, too often 
proved their infectious nature. 

The transmission of syphilis by inheritance, is another well es- 
tablished fact. It may be transferred by the semen to a healthy 
ovule; or by the ovule developed in the ovary of a syphilitic 
woman, or later during the time of gestation, if the mother acquires 
syphilis during that time. Whether syphilis be transmissible 
into the third generation, remains still an open question. 

Infection takes place when the syphilitic poison gets underneath 



CONSTITUTIONAL SYPHILIS. 705 

the epidermis, or beneath the epithelium of the mucous mem- 
brane of a healthy person. This may be effected in direct ways, 
by sexual intercourse, by kissing, by wet-nurses, by vaccination, 
by obstetrical examinations ;, in mediate ways, by the use of arti- 
cles which have been soiled by syphilitic poison, such as eating 
and drinking utensils, tobacco-pipes, cigar-holders, cigars, blow- 
pipes, surgical instruments, etc. 

The susceptibility to the syphilitic poison seems in some cases to 
be diminished by previous infection, but immunity by it is by 
no means so absolute as Ricord claimed; neither is inherited 
syphilis a shield against infection. Age does not essentially 
modify the susceptibility to the syphilitic virus. 

For practical purposes there may be made a division of the 
symptoms of syphilis into groups, according to the order in which 
they gradually develop, if not checked by proper treatment. 

The first or primary stage comprises the gradual development of 
the local symptoms at the point of infection, and the indolent 
gland swellings in the vicinity. Some six or eight weeks from 
the first appearance of the primary affection, signs of 

Constitutional Syphilis 

Or general blood-poisoning make their appearance, frequently 
accompanied by an eruptive fever. These signs of the secondary 
stage consist of: "superficial eruptions of the skin and mucous mem- 
brane, distributed symmetrically over both halves of the body ; 
falling out of the hair and disease of the nails; often anaemia; 
lymphadenitis universalis; irritative processes in the periosteum 
and interstitial cellular tissue of internal organs, which subside 
spontaneously without loss of tissue," or terminate sometimes in 
permanent derangements of function through adhesions and 
contractions. The duration of this stage varies from several 
months to a year, being followed by an intermediate stage of un- 
. certain duration, during which the disease remains either entirely 
latent or shows itself from time to time in various eruptions upon 
the skin and mucous membrane, but of less extent and intensity 
than in the previous stage. The blood-poisoning still existing 
is transmissible to the offspring. 

The tertiary stage is characterized by " local affections, for the 
most part asymmetrical, often occasioned by external causes, and 
consisting in cell-growth, having a tendency either to disintegrate 



706 MALE GENITALS. 

or to become encysted with caseous metamorphosis and new for- 
mation of connective tissue. Gummata of the various organs, 
ulceration, necrosis, and caries of skin and bone. General state 
of nutrition usually, though not always, bad." Its limits are un- 
certain ; in some cases it may be mixed up with the secondary 
stage ; as a rule, many years intervene between the infection and 
its outbreak ; it at last develops into confirmed syphilitic marasmus, 
where irremediable changes, as amyloid degeneration, destructive 
caseous pneumonias, dysenteric and other ulcerative processes, 
have taken place. 

THERAPEUTIC HINTS for Chancre.— Merc, sol., ulcer the size of a 
pea on the glans near the framum ; painful, itching, sore to the 
touch, and discharging offensive pus ; or several painful ulcers 
on the glans, on both sides of the frsenum, bleeding easily on re- 
tracting the prepuce or handling the parts; pain in the inguinal 
region on walking or on pressure upon the parts; or, ulcer the 
size and shape of a small bean on the glans near the fraenum of 
some depth, and its base covered with a thin layer of yellow pus; 
painful to the touch; prepuce red and swollen. (A. Fellger.) 

Merc, cinnab., the ulcer on the glans is surrounded by a red-yel- 
lowish or red ring; there are lentil-sized red-yellowish, or scar- 
let-red spots on the glans and prepuce. (A. Fellger.) Also in 
old, neglected, or badly treated indurated chancres, where Praec. 
rub. was of no avail; elevated chancres; exuberant granulations 
of the base of the ulcers; hard, callous, raised, indolent edges of 
the ulcer; mucous condylomata on the genitals, anus and lips; 
indolent buboes. 

Merc, prsec. rub., when Solubilis affects no change within eight 
or ten days; indurated, old, obstinate chancres; indurations after 
cauterization; excoriations on the glans; extuberances of the 
ulcers ; inflamed buboes. 

Merc, proto-iod., painless chancres with great swelling of the in- 
guinal glands, without disposition to suppurate ; swelling of ton- 
sils ; affection of testicles ; also secondary eruptions. (J. H. Mc- 
Clelland.) 

Merc, biniod., chancre and bubo particularly indolent ; other 
symptoms corresponding to the preceding. (J. H. McClelland.) 
Hard, red swelling of front of prepuce, appearing as thick and 
hard as a lead-pencil, with a hard chancre in its centre, entirely 
painless. (A. Fellger.) 



CONSTITUTIONAL SYPHILIS. 707 

Merc. subl. corr., phagedenic chancre, secreting a thin, ichorous 
pus. 

Merc, nitr., in old obstinate cases; dry fig-warts on thread-like 
pedicles; soft, pointed condylomata. 

Mercury, its oxide and chloride corresponds to chancres with 
steep, sharp cut edges ; the bottom of the ulcer appears lardaceous ; 
hard infiltration of the surrounding tissue. (Von Villers.) 

Arg. nitr., little ulcers on prepuce, spreading and becoming 
covered with a tallowy substance. 

Arsen., gangrenous degeneration with burning, restlessness and 
thirst. 

Caustic, acrid corrosive secretion or watery and greenish; com- 
plication with eruptions, gout or scurvy. 

Corall. rubr., ulcers fiat and extremely sensitive to touch, some- 
times bleeding; chancres on any part of the penis, or scrotum, 
very sensitive to touch. (A. Fellger.) 

Hepar., chancres secreting watery pus with diffuse borders and 
red bottoms, elevated above the surface. (Von Alllers.) Is in- 
dispensable where Mercury has been abused. 

Kali bichr., when the ulcer is round and deep, as if chisled out 
by a sharp instrument. 

Kreosot, the prepuce becomes blue and black with haemorrhage 
and gangrene. Let the penis remain hanging in a vessel filled 
with water, which is medicated by a drop or two of the first or 
second dilution. 

Laches., the areola of the ulcer assumes a purplish color; phage- 
denic chancres. 

Nitr. ac, ulcers are painful on slightest touch as if sticks were 
jagging them. (A. Fellger.) Chancres with raised edges and a 
disposition to bleed easily and profusely; inclined to spread in 
circumference with tendency to fungous growth; pains as of 
splinters; corrosive discharge; buboes threaten to suppurate. 
(J. H. McClelland.) Chancres with rhagades, characterized by 
fetor. (Von Villers.) After the abuse of mercury; unpainful 
ulcers, with gray, wasted edges, easily bleeding; or superficial or 
elevated ulcers, with zig zag edges; or ulcers with hard, callous 
edges; or ulcers with a dark, bluish, dirty basis, covered with a 
crust, from underneath of which ichor issues, or with exuberant 
granulations, forming a red, spongy basis, like raw flesh ; mucous, 
moist and other condylomata, like cauliflowers or pin-heads on 
thin pedicles ; or phagedenic, ulcerated condition of the entire 
surface; fistulous ulcer into the urethra; inflamed buboes. 



708 MALE GENITALS. 

Silic, excessive discharge, foul smelling diarrhoea, bloody and 
thin; inflamed, irritable, sore, with unhealthy granulation. 

Sulphur, chancres with board-like hardness of the red and swol- 
len prepuce; intermediate remedy in psoric persons. 

Thuja, round, unclean, elevated ulcers, surrounded with red- 
ness, usually moist and painful; condylomatous excrescences. 
(A. Fellger.) Moist condylomata; elevated ulcers, with exuber- 
ant granulations; after Nitr. ac, erosions on the female genitals, 
with abundant mucous secretions; erosions and rawness between 
the legs and on the sides of the scrotum ; constantly oozing of 
moisture; ulcers on the penis, cavity of mouth and throat. 

Besides, the following are recommended : Jacaranda caraba, 
Myrica cerifera, Phytol., Sanguin. 

THERAPEUTIC HINTS for Constitutional Syphilis.— Arg. nitr., 
chancre-like ulcer on the prepuce; urethra swollen, hard and 
knotty; sexual desire gone, the genital organs having become 
shrivelled; cock's-comb-like fig-warts around the vulva; horn- 
like excresences. 

Arsen., gangrenous and serpiginous ulcers ; tubercular syphilitic 
skin diseases. 

Asaf., affections of the long bones with severe nocturnal pains. 

Aur. fol. and mur., after the abuse of mercury; secondary ulcers 
on the scrotum; nightly pain in the bones: swelling of the skull- 
bones; swelling of the periosteum of the forearms and shin- 
bones; caries of the roof of the mouth and nose; ulcers on the 
tongue; falling out of the hair and great nervous weakness: utter 
despair and prostration of soul and body: attempts at suicide. 

Badiaga, whole convolutes of hard glandular swellings; buboes. 

Carb. an., buboes becoming phagedenic: gummata: skin tuber- 
cles. 

Carb. veg., suppuration of bubo; the parts are livid and mot- 
tled; partial falling off of hair, with furfuracious desquamation; 
yellow skin; pain in liver and spleen: palpitation of heart. (J. 
H. McClelland.) 

Caustic, fistulous ulcers ; corrosive ulceration of skin tubercles ; 
lupus: complication with gout and scurvy. 

Confirm, syphilitic sarcocele. 

Corall. rubr., syphilitic erosions, exuding a thin, badly-smelling 
ichor; constant trickling of mucus from the posterior nares into 
the fauces; smooth, copper-colored spots on palm of hand and 
finger. 



CONSTITUTIONAL SYPHILIS. 709 

Coryd., nodes on skull; ulceration of fauces; profuse secretion 
of mucus; fetid breath. 

Euphras., old, broad condylomata at the anus, with much burn- 
ing, especially at night. 

Ferr. iod., recommended for mercurial cachexia. 

Fluor, ac, skin tubercles on the forehead and face, even when 
ulcerating; elevated red blotches on palm of hands; squamous 
eruptions on the body (psoriasis guttata) ; syphilitic erosions, 
mucous tubercles; exostoses and nightly pains in the bones. 

Guaiac, tearing and stinging in the limbs; aching in the bones 
with swelling; tearing pains in the skull and bones of the nose; 
itching, tetter-like eruptions. 

Hecla lava, destructive ulceration of the nasal bones. 

Hepar, offer the abuse of mercury: falling out of the hair: pain- 
ful lumps on the head, and nightly pain in the skull-bones: sore- 
ness of the nose on pressure, with red, inflamed eyes ; eruptions 
around the mouth ; ulcerated gums, with flow of saliva ; swollen 
tonsils and hard glandular swellings on the neck, with sticking 
when swallowing, coughing, breathing, or turning the neck, as 
though a fish-bone had stuck fast ; suppurating buboes in the in- 
guinal region and axilla ; green, slimy, bloody stools ; inflamma- 
tory swellings of the knees, hands, and fingers; ulcers, with 
nightly burning, throbbing and stinging, bleeding easily ; 
nightly pain in the limbs, with chilliness , great nervous weak- 
ness. 

Iodium, mercurial cachexia ; salivation ; ulcers in the throat : 
chronic buboes very hard. 

Kali bichr., deep ulcer on the edge of the tongue ; ulcer on the 
velum palati, eating through ; fetid discharge from the nose ; 
caries of the bones of the nose, with profuse purulent discharge 
from the nose ; suppurating, solitary skin-tubercles, forming deep 
holes. 

Kali hydr., bubo very hard with a curdy, offensive discharge, if 
suppurating; thickening of the spermatic cord; ulceration of 
nose, mouth and throat with corroding, burning discharge ; lan- 
cinating pains in throat; system depressed; effusion of serum 
into the cellular tissue; induration of liver. (J. H. McClelland.) 
After abuse of mercury ; tuberculous pustules in the face ; roseola 
on chest and extremities ; discolored, large ulcers on the skin ; 
swelling of the bones ; nightly bone-pain ; bloody stools, with 
tenesmus ; falling out of the hair. 



710 MALE GENITALS. 

Laches., mercurial syphilis, with ulcerated sore throat, causing 
a constant provocation to cough, with retching ; painful degluti- 
tion ; regurgitation of drink through the nose ; earthy, yellowish 
appearance of the face, with small red blood-vessels shining- 
through the skin ; coryza, nose red and sore ; terrible headache ; 
nightly pain in the limbs. 

Lycop., secondary, tettery-like eruptions and ulcers in the throat 
of a dark, yellowish-gray color; cough and hoarseness, from simi- 
lar affection of the larynx ; coppery eruptions on the forehead, 
and cachectic appearance of the face ; dry, pediculated, painless, 
condylomata on the sexual organs; nightly pain in the limbs dur- 
ing- wet weather; low-spirited; desponding; nervous weakness. - 

Mercurial preparations, compare Chancre. 

Mezer., mercurial syphilis, with or without affection of the bones; 
chronic sore throat; dark redness of the fauces; worse every win- 
ter, with burning dryness extending into the larynx; hoarseness; 
hawking of phlegm. 

Natr. mnr., if the primary sores have been burnt by nitrate of 
silver or lunar caustic. 

Natr. sulph., granulated inflammation of the inside of the eye- 
lids ; swelling and suppuration of the axillary glands ; ulcer on 
the outer side of the thigh ; knotty, wart-like eruption on the 
anus, between the thighs, on the forehead, scalp, back of the 
neck, and chest ; swelling of the ribs near the sternum ; stiffness 
of knees, and cracking of joints ; pain in the bones. Compare 
Thuja. 

Nitr. ac, mercurial syphilis; tonsils red and swollen, uneven, 
covered with little ulcers of the size of a pin's head ; soft palate, 
highly inflamed ; deep, irregular-shaped ulcer on the edge of the 
tongue ; foul breath : single, moist sores on the scalp, burning ; 
suppurating pustules all over the face, with broad red circum- 
ference, forming crusts ; large, soft protuberance on the wings of 
the nose, covered with a crust : brown spots on the glans, of the 
size of a lentil, peeling off; squamous eruption, like psoriasis; 
hard, brownish, little knots on the scrotum and perineum, which 
suppurate. 

Petrol., brown spots on the arms, neck, chest and lower limbs ; 
falling off of hair; rheumatic stiffness of shoulders and ankles. 
(Bell.) 

Phosph. ac, mercurial syphilis ; ulceration of the lips, the gums, 
and the soft palate ; swelling of the bones ; pain in the bones ; 



CONSTITUTIONAL SYPHILIS. 711 

condylomata; carbuncle-like ulcers of the skin, with a copper- 
colored circumference. 

Phosphor., falling out of the hair leaving exposed ulcers* on the 
scalp, implicating the cranial bones ; syphilitic psoriasis in the 
palms of the hands and the soles of the feet ; syphilitic roseola ; 
squamous eruptions ; mercurio-syphilitic ulcers on the prepuce ; 
bone-pain and exostosis. 

Phytol., sore throat ; ulcers on the genitals ; severe pains in the 
arms and legs, from the elbows and knees down to the fingers 
and toes, with cedematous swelling of the affected parts ; pain 
aggravated by motion and contact ; feet and legs covered with 
pale, red spots, about the size of a dime ; more scattered on the 
arms, face and neck ; previous use of mercury. 

Psorin., moist, itching and burning condylomata on the pre- 
puce ; sore corners of the mouth ; dry, tetter-like eruptions in the 
hollow of the knees. 

Sabina, fig- warts, with intolerable itching and burning; exu- 
berant granulations. 

Sanguin., roundish or oval, whitish and raised patches on the 
mucous membrane of the mouth, nose, prepuce and anus ; a diph- 
theritic exudation, which, when wiped off, leaves a raw surface 
behind ; congestion of the head ; throbbing headache from the 
nape of the neck to the head ; swollen veins in the temples. 

Sarsap., mercurial syphilis ; squamous eruptions ; bone-pain. 

Sepia, syphilitic erosions in women. 

Silic, mercurio-syphilitic ulceration of skin and bones. 

Staphis., mercurial syphilis; dry, pediculated fig- warts and mu- 
cous tubercles ; nervous weakness. 

Stillin., extreme bone-pains ; nodes on head and legs. 

Sulphur, mercurial syphilis; itching ulcers, which are soon cov- 
ered with a crust, discharging pus from underneath ; cock's-comb- 
like excrescences on glans, soft, spongy, easily bleeding ; excoria- 
tions on the genitals, with burning ; copper-colored spots on fore- 
head ; hard, large and inflamed buboes. 

Thuja, erosions in the female genitals, with profuse gonorrhceal 
discharges ; erosions between the thighs and on scrotum ; in the 
fauces, with mucous tubercles ; condylomata, tubercula mucosa ; 
decay of teeth near the gums. 



712 MALE GENITALS. 

Condylomata, Sycosis, Fig-warts. 

These excrescences are a morbid growth of the skin and 
mucous membrane, or, better defined, of the subcutaneous and 
submucous cellular tissue. They are of different external ap- 
pearance, according to their coating. When they are covered by 
the epidermis, they appear dry, hard, horny, like common warts; 
when covered with thin epithelium, or when they are entirely 
bare and excoriated, they appear soft, moist and secrete more or 
less of a slimy, acrid, badly-smelling fluid. These latter are the 
genuine syphilitic condylomata or tubercula mucosa. 

Their forms are likewise various; some are flat, upon a broad 
basis; others are conical, growing on a pedicle; others appear 
like a cock's-comb. The flat fig-warts are chiefly found around 
the anus, between the glutseus muscles; on the perinseum, scro- 
tum, external skin of the penis, glans penis, and on the external 
surface of the labia in women; whilst the conical and pediculated 
are usually found in the entrance of the vagina, on the clitoris 
and even far back in the vagina, and on the neck of the womb ; 
in males on the interior surface of the prepuce ; also between the 
nates. They sometimes grow so luxuriantly that the whole 
vagina and interior surface of the prepuce is covered by them. 
A third kind is quite small, in the shape of pins' heads, which 
are generally found around the corona in men and on the interior 
surfaces of the labia in women. In secondary syphilis they appear 
also in other localities, especially on the tongue, corners of the 
mouth, chin, face, forehead, eyelids, iris, scalp, meatus auditorius, 
axillae, nipples and between the toes. Soon after the outbreak of 
this pest in the middle ages Ave read of condylomatous excres- 
cences in the face, which were of a finger's length and which 
caused for their bearers more ridicule than compassion. 

THERAPEUTIC HINTS.— For the mucous tubercles the main reme- 
dies are Cinnab., Sublim., Nitr. ac, Thuja. 

Fig-warts, when complicated with gonorrhoea, require Thuja, 
Sublim., Cinnab., Nitr. ac, Sulphur. Lycop. 

When complicated with chancre, Cinnab., Xitr. ac, Phosph. ac, 
Staphis., Thuja, 

When flat, Magnes., Nitr. ac 

When exuberant, like cauliflowers or mulberries, Thuja, Staphis. 

When fan-shaped, Cinnab. 



^ 



INGUINAL BUBO. 713 

When growing on pedicles, Lycop., Nitr. ac. 

When conical, Solub. 

When dry, Thuja, Staphis., Solub., Sublim., Nitr. ac, Lycop. 

When moist, suppurating, Nitr. ac., Thuja, Sulphur, Euphras. 

When soft, spongy, Sulphur. 

When intolerably burning and itching, Sabina. 

The Inguinal Bubo 

Consists of a swelling of the inguinal lymphatic glands, with a 
tendency to form abscesses in consequence of syphilitic infection. 
As chancres may appear on other parts than the genitals, so, also, 
may buboes appear in other parts: in the axilla, under the 
maxilla, on the neck. Buboes may also form primarily (without 
previous chancre on the penis) by immediate absorption of the 
syphilitic virus. The period of time which elapses between the 
first appearance of chancre and that of bubo varies from eight 
days to six weeks. 

Symptoms. — Before any thing can be seen the patient experi- 
ences a painful tension in the inguinal region, which sometimes 
extends into the thigh, making walking quite difficult ; soon af- 
ter the patient feels feverish, chilly, and there appears a roundish 
swelling in the inguinal region, which is painful to contact and 
motion. It is usually hard, grows, in the course of some days, to 
the size of a pigeon's egg, and larger, and becomes dark red. If 
not arrested in this stage it soon commences to assume a more 
doughy feel, with painful throbbing ; finally it fluctuates, breaks, 
and discharges a quantity of thick pus, which at last becomes 
watery ; now it heals, either like any other abscess, or the wound 
assumes a chancre-like aspect, with hard, callous edges. In bad 
cases, it may even assume a phagedenic or gangrenous form, 
and cause terrible destruction of the surrounding parts. 

All buboes do not run this acute course. The so-called indo- 
lent, torpid or atonic buboes form quite slowly, without pain or 
fever, and continue so until they reach a certain size, which they 
retain in a seemingly unaltered condition for weeks, or even 
months, until they finally suppurate and discharge. The so- 
called scirrhous bubo may remain for years in the same con- 
dition. 

Its Diagnosis is easy enough, if we ascertain the pre-existence 
of chancre. It may, however, be confounded with an incarcer- 



714 MALE GENITALS. 

ated testicle within the abdominal ring; therefore, Ricord ad- 
vises first to count the testicles before pronouncing an inguinal 
swelling a bubo. The inguinal glands may swell from other 
causes. In children, scrofulous swellings of these glands are not 
unfrequent. We shall, in some cases, no doubt, have to fall back 
on the history of 'the case, which may tax our skill in cross-ex- 
amination. 

THERAPEUTIC HINTS.— Apis, red, hot, shining swelling, with 
great stinging pain and sensitiveness. 

Arsen., when the open bubo assumes a greenish aspect. 

Aurum, after the abuse of mercury, with nightly pains in the 
bones. 

Badiaga, bubo stone-hard and uneven, a conglomeration of in- 
durated glands; violent stitching pain through it at night, as 
though a red-hot needle were thrust into it. Suppressed chancre 
by cauterization and mercurial ointments, leaving elevated and 
discolored cicatrices ; general cachectic appearance and rhagades 
of the skin, here and there. 

Carb. an., for hard buboes which threaten to suppurate; it causes 
resorption where there is even some fluctuation discoverable; old, 
maltreated buboes, cut open or cauterized, presenting large, terri- 
ble ulcers, with callous edges and a secretion of offensive ichor. 

Hepar, after the abuse of mercury, for open buboes, which do 
not heal, and when there is a psoric taint of the system. 

Kali hydr., after mercurial treatment ; ulcerating bubo, with fis- 
tulous openings, and discharge of dark, thin, offensive, and cor- 
roding ichor ; scrofulous individuals. 

Laches., old protracted sj T philitic mercurial buboes : hectic fe- 
ver, sore throat, and the most violent headache, either in the 
back or front of the head. 

Mercurial preparations, compare what has been said under the 
chapter on Chancre. 

Nitr. ac, after the abuse of mercury, when Carb. an. has not 
been sufficient to reabsorb the swelling, and especially if the still 
existing chancre presents exuberant granulations on its base. 

Sulphur and Silic. are especially indicated for old, discharging 
buboes which do not heal, although other syphilitic symptoms 
have disappeared. 

Besides these remedies, there have been recommended Buboin. 
Phytol., Sanguin. 



SYPHILITIC SKIN DISEASES. 715 

Syphilitic Skin Diseases. 

The various affections of the skin in consequence of syphilis 
go under the name of Syphilides. Syphilides as a rule are char- 
acterized by a peculiar red color, which is perhaps best designated 
by the term "coppery red." It is most pronounced in persons 
with dark complexions; in persons with very pale anaemic skin 
it may at first be wholly wanting, or appear only as the exan- 
them begins to wane with a yellowish color. 

The syphilides consist of a cellular infiltration proceeding from 
the blood-vessels ; but developing only gradually and at different 
localities, they appear frequently in different forms, so that we 
see macules, papules, vesicles and pustules side by side in one 
person, as different stages of development, all of which may 
ultimately assume the form of ulcers. This polymorphous char- 
acter, however, belongs not exclusively to syphilides, we find it 
also, though in a less degree, in eczema and scabies. 

Another characteristic mark of the syphilides is their annular 
form, similar to that observed in herpes circinatus. It is often 
very distinct, too, on the mucous membrane, especially on the 
tongue, on the hard and soft palate and on the glans penis. 

Syphilides finally are characterized by an absence of itching, or 
any other sensation, although exceptions do occur, especially when 
the exanthem comes on very acutely. 

The various forms of syphilides are : 

1. The Macular syphilide, or Roseola syphilitica consists of a cir- 
cumscribed hyperemia with but slight infiltration, and appears 
in perfectly even, rose-colored, or darker colored spots, of a size 
varying usually from that of a lentil to that of a pea, with a 
roundish or irregular shape. After it has existed for several 
days it leaves under pressure a yellowish stain, and gradually 
assumes a coppery hue. When the spots are elevated it is called 
erythema papulatum. 

Roseola syphilitica is usually the first of all skin affections, 
and sometimes the sole eruption that occurs during the earlier 
course of the disease. It may appear in only a few spots upon 
the sides of the chest and in the groin, and again it may be 
disseminated over the whole body like an eruption of measles. 

2. The Papular syphilide consists of a circumscribed infiltration 
of the papillary bodies of the cutis. It varies from the size of a 
barley-corn to that of a split pea, and in color from red to brown- 



716 MALE GENITALS. 

ish-red; it is hard to the touch, but smooth upon the surface. 
Later its epidermis loosens and is rubbed off when its summit 
presents a dark red and shining appearance, which again is 
covered by a thin crust from the oozing of a little serum. In the 
palms of the hands and soles of the feet the papules are not very 
prominent on account of the thickness of skin, but they appear 
only as red circular spots, which become denuded of their epider- 
mis, and which are usually designated by the name psoriasis 
palmar is and plantaris. 

The papular syphilide may appear anywhere upon the surface 
of the skin, but is mostly seen on the borders of the scalp, on the 
forehead (corona veneris), on the back of the neck, especially in 
women, and in all places where the skin forms folds or depres- 
sions, for instance on the chin, between the nose- wings and cheeks, 
behind the ears, on the borders of the axilla?, in the elbows and 
in the hollows of the knees. Where these folds of the skin are 
in continual contact with each other, for instance on the external 
female organs, the scrotum, beneath the dependent breasts, in 
the navel, about the anus, at the preputial orifice, the angles of 
the mouth, between the fingers and toes, these papules are very 
apt to assume the form of condylomata lata. 

The eruption of the papular syphilide is often attended with 
fever, thus simulating somewhat an outbreak of small-pox. where- 
fore syphilis received from the French the name of rerole grass or 
wrote. It is either one of the first constitutional signs of syphilis 
or develops. gradually from a roseola syphilitica, or does not ap- 
pear until some weeks after this has disappeared. It is often ac- 
companied by violent pains in the bones or iritis. 

3. The Squamous syphilide consists of a coalescence of several 
papules, or a gradual enlargement of a single papule with des- 
quamation of the epidermis, thus bearing close resemblance to 
the patches of a common psoriasis. However, it is covered, espe- 
cially towards the borders, with loose epidermic scales, or rather 
thin yellow crusts, by which it may be distinguished from the 
white thick desquamation of psoriasis vulgaris. Besides, it does 
not appear on the knees or elbows, which is the favorite seat of 
common psoriasis. 

The squamous syphilide also becomes transformed into' flat 
condylomata in favorable situations. 

4. The Lichen syphiliticus consists of an infiltration of the follic- 
ular walls, with only scanty, or no exudation in the follicles. In 



SYPHILITIC SKIN DISEASES. 717 

their simplest form they resemble those enlargements of the folli- 
cles which occur in many persons upon the dorsal surface of the 
upper arm, in consequence of an accumulation and desiccation 
of the secretion, as hard granules like dried gum, which can be 
excavated with the finger-nail. 

The lichen appears usually in groups, at first slightly reddened, 
assumes soon a yellowish color, peals off and leaves no pigment 
spots behind (Miliary papular syphilide). When there is exudation 
into the follicle, groups of little vesicles form, which turn into 
pustules. These crust over and, after drying, leave small, dark 
scars behind (Herpes syphil.). Or, the infiltration spreads further 
around, and causes the entire surface of the skin, which was oc- 
cupied by the papular group, to be converted into a desquamat- 
ing, psoriasis-like group (Eczema syph.). Or, there is an acute 
suppuration in the follicle in connection with the infiltration 
causing acuminate pustules upon a red or copper-colored base 
(Acne syphilitica). This form is so similar to common acne that 
the distinction between the two must be based upon other syphi- 
litic symptoms present or past. 

5. The Pustular syphilide consists of an infiltration with subepi- 
thelial suppuration and superficial ulceration. The pus in these 
eruptions is not situated in the follicles, but underneath the epider- 
mis, independently of the follicles. The pustules develop rap- 
idly in places where the skin is tender, namely, beside the face, 
in the flexor surfaces of the extremities, on the sides of the trunk, 
and in the palm of the hand where there are no follicles. They 
are also more superficial and leave only very shallow depressions, 
even immediately after the crusts have fallen off (Pemphigus 
syphiliticus). Sometimes the epidermis is raised by a cloudy 
fluid, which soon becomes purulent and is often tinged with blood, 
over a reddened base. Such bullae appear in isolated spots, in 
preference on the legs below the knees (Ecthyma syphiliticum). 
After dessioation there forms at times superficial excoriations be- 
neath the scabs, and at other times deep ulcer.s, which extend at 
the edges and occasionally assume a serpiginous form (Ecthyma 
superficial and profundum). It is a manifestation of the later 
periods of syphilis and an evidence of a poor constitution. When 
the epidermis of a bulla forms a scab, while the ulcerative pro- 
cess underneath advances slowly beyond its edge, there gradually 
is produced a large, dirty, brownish-green, stratified crust in the 
shape of a cone, which rests upon a flat, ulcerated surface (Rupia 



718 MALE GENITALS. 

syphilitica). Such ulcers, proceeding from rupia, may continue 
to extend for years, and convert extensive tracts of skin into 
cicatricial tissue. 

Rupia is often a manifestation of the later periods of syphilis, 
though it may break out within the first six months after infec- 
tion. 

6. The Tubercular syphilide consists of deep infiltration and dis- 
integration, or a gummous formation. At the commencement 
only a papule is felt in the skin, without redness. Gradually the 
papillary body becomes likewise involved, and the tubercle ap- 
proaches the surface, when it causes redness of the skin, desqua- 
mation of the epidermis or scanty serous exudation, which, on 
drying, forms a small crust upon the summit of the tubercle. 
These tubercles often develop in groups of a circular or semi-cir- 
cular form (Dry tubercles). Or, the epidermis above the tuber- 
cle is raised in the form of a pustule which quickly desiccates, 
while underneath ulceration proceeds, similating a rupia or as- 
suming at once the form of a sepiginous ulcer. Or, the process 
of softening may be similar to the development of a furuncle ; 
it gradually becomes bluish-red, and when it breaks discharges 
a grayish-yellow, gummy-like matter, instead of a core of con- 
nective tissue, as in the true furuncle. The remaining cavity 
gradually either granulates and cicatrizes, or enlarges and assumes 
a serpiginous character (Softening and Disintegrating tubercles). 
These forms of the syphilitic tubercles present a marked simi- 
larity to different forms of lupus, whence the name Lupus syphi- 
liticus. The tubercular syphilide belongs to the tertiary group of 
syphilis. 

7. The Loss of hair, Alopecia, occurs without any visible change 
in the skin. The hair merely loses its lustre, becomes dry, and 
often discolored, and falls out in large quantities when combed. 
It is an early symptom of constitutional syphilis, but may not 
occur until in the later stages. 

8. Alterations of the nails, such as growing thinner, becoming 
furrowed or brittle, may take place without any obvious affection 
of the matrix; but deformities of the same may also be brought 
on by various syphilides attacking the matrix. 

THERAPEUTIC HINTS.— Mercurial preparations, Xitr. ac, Thuja, 
Aurum, Lycop., Staphis., Kali hydr., Laches., Sulphur, Hepar, 
Sarsap., Petrol., Cuprum, Corall. rubr., Arsen., Graphit. and many 
more. 



SYPHILITIC AFFECTIONS OF MUCOUS MEMBRANES. 719 

Syphilitic Affections of the Mucous Membranes. 

Some of the just described syphilides may also affect the 
mucous membranes, for instance: 

The Erythematous syphilide occurs in the throat in the form of 
a diffuse redness, sometimes accompanied by a slight oedema of 
the mucous membrane. 

The Papular syphilide appears as moist or mucous patches in 
the mouth and throat, bearing the greatest resemblance to the 
effect produced by a very superficial cauterization of the mucous 
membrane by nitrate of silver. Upon the tongue the syphilitic 
papule forms usually round level spots which often enlarge in 
circumference while receding in the centre, and thus assume the 
annular form. The same occurs on the hard palate. In the 
female genitals and in places where surfaces lie in contact with 
each other, the mucous patches become flat condylomata, which 
often are converted into condylomatous ulcers, similating closely 
the primary affection. The secretion of the flat condylomata is 
in the highest degree infectious. 

The Squamous syphilide also becomes often transformed, in 
favorable situations, into flat condylomata. 

The Ecthyma is often accompanied with aphthous-like sores in 
the mouth, deep ulcers of the tonsils, or destructive ulcerations 
upon the soft palate. 

The Syphilitic tubercles of the mucous membrane of the mouth 
and throat are usually not seen until ulceration has taken place. 
The ulcers have sharply cut edges, a yellowish purulent base 
with great swelling and redness around them; they spread often 
extensively upon the posterior pharyngeal wall ; they occur also 
in the large intestine, especially in the lower part of the rectum 
and in the trachea. 

THERAPEUTIC HINTS.— Mercurial preparations, Aurum, Kali 
bichr., Kali hydr., Laches., Lycop., Mezer., Nitr. ac, Sanguin, 
Thuja. 

Syphilitic Affections of the Periosteum, of the Bones and 
Cartilages. 

They are always attended with severe pains in the bones, of a 
boring, grinding nature, and always worse at night from evening 



720 MALE GENITALS. 

till towards morning, when, with a slight perspiration, they usu- 
ally abate. Gradually a structural change is observable; the 
periosteum commences to swell, forming so-called tophi, and when 
the inflammation spreads to the bones, causing swelling of the 
bones (exostosis), which may terminate in necrosis and caries. 
Such structural changes attack the skull bones, which, when 
they are on the inside, may cause convulsions, paralysis, amau- 
rosis and deafness. Those which attack the bones of the nose 
cause horrible disfigurations of the face. It also attacks the 
vertebra?, destroying portions of them, and the cartilages, although 
not so frequently. The cartilage of the nose is destroyed as well 
as the bones, and so have the cartilage of the sternum and the 
cartilages of the larynx been found destroyed. 

THERAPEUTIC HINTS.— Pain in the hones, Arsen., Aurum, Fluor, 
ac, Guaiac, Laches., Mercur., Mezer., Xitr. ac, Phosphor., Phosph. 
ac, Phytol., Staphis., Stilling., Sulphur. 

Tophi and exostosis, Asaf, Aurum, Fluor, ac, Lycop., Mezer., 
Phosphor., Phosph. ac, Staphis., Sulphur, Silic, Ruta, Sabina. 

Caries and necrosis, Asaf, Aur., Gale carb. and jod., Fluor, ac, 
Kali hydr., Mercur., Nitr. ac, Silic, Hepar, Lycop., Phosphor., 
Mezer., Sulphur. 

Syphilitic Contractions of Muscles and Tendons. 

These take place in rare cases, where the syphilitic virus at- 
tacks the muscles and tendons, causing plastic exudation within 
and around them, and thus shortening them. 

Gummata in the Subcutaneous and Submucous Cellular 
Tissue. 

These usually form at a later period, and appear as little, pain- 
less, movable kernels under the skin. They grow slowly and 
commence finally to suppurate, leaving deep, cicatrized holes, or 
chronic ulcers. 

Arsen., Aurum, Bellad., Calc carb., Carb. veg., China, Grapb.it., 
Mercur., Mezer., Phosph. ac, Plumbum, Ruta. 



SYPHILIS CONGENITA SIVE HEREDITARIA. 721 

Syphilitic Affections of Inner Organs. 

a. Brain Affections. They manifest themselves in various ways, 
as, violent headaches, hemicrania, sleeplessness, dizziness ; or as 
hemiplegia, imbecility of mind, amaurosis, deafness, epilepsy, 
catalepsy, and are caused either by chronic inflammation of the 
membranes, or formations of tubercular masses, or syphilitic ex- 
oxtosis on the inner plate of the skull bones. 

The diagnosis is difficult. We may suspect such changes, if 
we find a right to do so from the history of the case. 

b. Lung Affections set in frequently in consequence of suppressed 
chancres, either as ulcerative processes, as bronchitis and asthma. 

c. Liver, Spleen, Intestinal Affections are of various kinds and 
have been spoken of under the corresponding chapters. 

Syphilis Congenita sive Hereditaria. 

In some cases the child is destroyed by syphilitic infection 
while yet a foetus; or it may be born alive prematurely; or be 
still-born at full term ; or be born at full term apparently 
healthy, when sometime afterwards the constitutional taint de- 
velops itself. 

The infection may have been transmitted, as stated before, by 
the semen, by the ovule, or later during gestation. The more re- 
cent the syphilis in the parents at the time of conception, the 
greater will be the liability to abortion. When the foetus dies in 
utero, it is usually born in a state of maceration; if carried 
nearly its full term, it shows the syphilitic signs either on the 
surface of the body, or in internal organs, and invariably in the 
epiphysis of the long bones, where the cartilage layer is enlarged 
and softened, the zone of ossification is thickened, projecting with 
irregular prolongations into the cartilage layer, whereby the 
union of the two becomes less firm, so that the epiphysis is liable 
to separate entirely from the shaft of the bone, or the rib from its 
cartilage. 

When the child is born alive, it usually is small, undeveloped 
and presents a peculiar oldish appearance, has a weak, plaintive 
voice, a stoppage of the nose, sore corners of the mouth, and its 
skin is either already covered with a rash, or shows, in a few days, 
papules or pemphigus. Such children perish in a short time 
from diarrhoea, or suppurations with all signs of marasmus. 



722 TESTES. 

Sometimes the only apparent symptom of a seemingly healthy 
child is a nasal catarrh with stoppage of the nose, and coincident 
with it or following soon after a macular, or oftener a papular 
eruption, which may be limited to a few bright red papules upon 
the buttocks, or cover the entire body, but especially the face, ac- 
quiring by degrees the coppery tint. By and by the nasal dis- 
charge becomes purulent and excoriates the neighboring parts, 
and in the mouth and throat mucous patches appear. Bad 
cases soon lead to destruction ; mild cases may improve, but de- 
velop a most striking depression or flattening of the nasal ridge 
and a marked prominence of the frontal protuberances with 
symptoms of hydrocephalus. The children become very restless, 
cry a great deal, especially at night; later manifest themselves a 
want of proper intellectual unfoldment and striking idiosyncra- 
sies of character, and the upper permanent incisor teeth appear 
as if they were scooped out at their lower surface. 

The outbreak of these symptoms is very uncertain ; the latest 
period, as stated by different observers, is at from one week to 
several months, occurs most frequently, however, from the fifth 
to the eighth week after birth. The sooner the symptoms ap- 
pear, the worse for the child. If it live through the acute stage 
there may occur, commonly during the period of the second den- 
tition, or at the time of puberty, especially in girls, another train 
of symptoms of which may be mentioned : interstitial keratitis, 
eruptions, serpiginous ulcerations of the skin, or affections of the 
bones, epilepsy, chorea, paralysis. The treatment find under 
Constitutional Syphilis. 



DISEASES OF THE TESTES. 

Hydrocele. 

The testicles and epididymis are enclosed within a serous 
membrane, like the peritoneum, from which, in fact, it is a mere 
continuation. As such, it is a closed sac, and consists, like the 
pleura and the peritoneum, of two blades, the tunica vaginalis 
propria and the tunica vaginalis rcfle.ra. Like all serous mem- 
branes, it is liable to exudation, and if that takes place, it consti- 
tutes what is called hydrocele or dropsy of the scrotum. 

It is either a symptom of general dropsical disposition, in con- 
sequence of hydremia, as found in old age, or in consequence of 



HYDROCELE. 723 

tuberculosis or other chronic diseases, corresponding entirely to 
hydrothorax and ascites; or it is the result of some inflammatory 
or mechanical irritation, in consequence of orchitis, urethritis, or 
in consequence of external injuries — a bruise, a fall, a kick, etc., 
as found in otherwise healthy and young persons, even in chil- 
dren, and then it corresponds to pleuritic and peritoneal effusions. 
This latter may become chronic, and the secretion of serum con- 
tinue so that the swelling attains the size of a head. The scrotum 
then appears smooth, tense, glistening; the testicle is compressed, 
becomes atrophied, and may gradually disappear; then it pre- 
sents the appearance of a transparent bladder. In consequence 
of undue irritation, the testicle may grow larger, become indu- 
rated, form into cysts; the exuded fluid may coagulate, become 
turbid by the admixture of blood or pus globules; adhesions 
may form, etc. All these are circumstances by which the original 
nature of the disease may become deeply concealed. The exu- 
dated fluid consists chiefly of a colorless, clear or yellowish fluid, 
which, however, now and then becomes turbid by admixture of 
pigment, blood, fibrine, fat, mucus, epithelium and semen, so 
that it assumes different colors, greenish, dark green, brown and 
even black. 

The presence of semen is a remarkable phenomenon, the solu- 
tion of which has been found only by the latest researches of 
Luschka, on the appendices of the testicles. According to 
Luschka, there is, under the head of the epididymis, a roundish 
vesicle of the size of a pea, which stands in immediate connection 
with the seminiferous tubuli of the epididymis. It therefore 
almost always contains seminal fluid. The vesicle or cyst now 
seems, under certain circumstances, to enlarge to such a degree 
that it forms an encysted, spermatic hydrocele ; or it bursts, and 
diffuses its seminal fluid into the already-existing collection of 
serous fluid. 

In an ordinary hydrocele, the testicle always lies in the upper 
and posterior part of the scrotum, whilst the lower cavity of the 
scrotum is filled with the respective fluid. In exceptional cases, 
however, a previous inflammation may have caused adhesion 
between the testicles and the lower part of the scrotum; then, of 
course, the testicle is fastened down and the collection of fluids 
gathers above it. It is well to bear this in mind. The diag- 
nosis rests on these points which have been detailed. In external 
appearance it resembles mostly a scrotal hernia; but is easily 



724 TESTES. 

distinguished from it, if we compare the history of hoth; the 
neck of the hernia, which is traceable into the abdominal ring; 
the impulse which is felt in a hernia when coughing; the symp- 
toms of strangulated hernia, etc. ; so that hesitation between the 
two is scarcely possible. 

Hydroceles which are dependent upon a general hydrsemic state 
of the blood must be treated with reference to this whole general 
state and its sj^mptoms. Hydrocele, in consequence of a blow, re- 
quire Arnica. Pulsat., Conium. 

Those of unknown causes, Apis, Aurum, Calc. carb., Digit., 
Graphit., Iodium, Kali hydr., Mercur., Psorin., Pulsat., Rhodod., 
Rhus tox., Silic, Sulphur. 

Orchitis, Inflammation of the Testicles. 

Pathologically speaking, the inflammation may attack the 
testicle itself, or the epididymis, or their lining, the tunica 
vaginalis. 

It may be caused either by external violence or by an extension 
of inflammatory processes of related organs, such as the prostata. 
the neck of the bladder, the urethra, or, what is most frequently 
the case, by gonorrhoea or syphilis. There is also an orchitis 
caused by a metastasis in parotitis or mumps. 

The product of inflammation is either: 1, A serous exudation, 
especially in epididymites and vaginalitis. and it is the same thing 
with the above-described acute serous hydrocele; or, 2, Arthrous, 
plastic exudation, which causes infiltration, swelling, and indura- 
tion of the epididymis: or. 3, .-1 serous haemorrhagic exudation in 
acute specific inflammations; or, 4, A purulent exudation, which 
takes place in the parenchyma of the testicle itself. 

The plastic exudation generally gives rise to chronic enlarge- 
ments of the epididymis, which may reach a considerable size 
and hardness. 

The purulent exudation may be reabsorbed, or may form ab- 
scesses, which gradually break through the scrotum. Such ab- 
scesses heal only very slowly, usually forming fistulous openings. 

A genuine orchitis very much resembles an incarcerated scrotal 
hernia. The pain is very acute, running along the spermatic 
cord, causing colicky pains and vomiting. "We have in such 
cases to ascertain where the swelling commenced. In orchitis it 
grows from below upwards ; in hernia it comes from above down. 






CARCINOMA TESTIS — VARICOCELE. tZi) 

Sarcocele, Hydrosarcocele is a chronic inflammation of the testi- 
cles, with infiltration of the parenchymal substance, in conse- 
quence of which the tubuli seminiferi become obliterated. It is 
slow in growing, usually without pain, and may involve the epi- 
didymis or start from it. In appearance it is an inelastic, smooth, 
oval tumor which, upon pressure, does not show any sensitive- 
ness so natural to the healthy organ. In the latter stages of its 
development it is sometimes accompanied with an effusion within 
the tunica vaginalis, constituting what is called hydrosarcocele. 
It may be the result of an incomplete resolution of an acute orchi- 
tis, or the consequence of gonorrhoea. The syphilitic form often 
attacks both testicles, one after the other. 

THERAPEUTIC HINTS.— Inflammation in general : Aeon., Arnica, 
Aurum, Bellad., China, Clemat., Euphras., Mercur., Nux vom., Pul- 
sat., Rhodod., Rhus tox., Staphis., Spongia, Zincum ; from bruises : 
Arnica, Baryta, Pulsat., Zincum ; from taking cold : Clemat., Pul- 
sat., Rhus tox. ; from gonorrhoea : Cannab., Clemat., Gelsem., Mer- 
cur., Pulsat.; looking bright red: Bellad.; dark red: Rhus tox., 
Euphorb. ; chronic hardening and swelling : Arsen., Aurum, Baryta, 
Bellad., Calc. carb., Carb. an., Clemat., Conium, Graphit., Iodium, 
Kali carb., Kali hydr., Lycop., Nitr. ac, Plumbum, Spongia, Thuja. 



Carcinoma Testis. 

The most frequent form is the medullary cancer, which gener- 
ally attacks young persons, even children. The fibrous cancer, 
or scirrhus testis, is found more in old age. 

Cancer usually attacks but one testicle. Its causes are not 
known. Bellad.? Carb. an.? Conium? Phosphor.? Phytol.? 
Thuja? 

Varicocele. 

This consists of a varicose enlargement of the veins of the sper- 
matic cord, epididymis and testicle, and gives rise to a knotty 
swelling, which feels between the fingers like a convolution of 
earth-worms. It gets smaller under compression or in a hori- 
zontal position, and enlarges again on standing upright. It is 
almost always found on the left side, because the spermatic vein 
of that side has a longer and more tortuous course than that of 



726 PROSTATA. 

the right side, and is also more liable to compression by accumu- 
lation of fceces in the sigmoid flexure. The affection is there- 
fore similar to the varicose state of the hsernorrhoidal veins, and 
may have similar causes. In some cases it produces no inconve- 
nience; in others it is very troublesome, producing a drawing, 
dragging sensation, extending from the loins into the limb, espe- 
cially when walking or standing, and in hot weather ; also weak- 
ness, prostration, paleness, and great dejection of spirits. 

Arnica, Bellad., Calc. carb., Collins., Fluor, ac, Hamam., Laches., 
Lycop., Nux Yom., Pulsat., Sepia, Sulphur. 

Spermatocele 

is a swelling of the spermatic cord and especially of the epididy- 
mis in consequence of a retention and collection of semen in per- 
sons who have been addicted to excesses in venere or masturba- 
tion, and suddenly stop this bad habit without being able to stop 
also their lascivious thoughts. The testicle is drawn up towards 
the abdominal ring, the epididymis and spermatic cord is swol- 
len, and painful to touch, also on standing and walking. The 
penis is usually in a state of semi-erection. All may pass off in 
the course of several hours, when the mind is differently em- 
ployed, but the swelling may become stationary by frequent re- 
petitions, and then it is often accompanied with varicocele. 
Pulsat. is often of use, also cool sitzbaths. 



DISEASES OF THE PROSTATA. 

Prostatitis, Inflammation of the Prostate Gland. 

Primarily it is of rare occurrence, but is occasionally brought 
on by traumatic causes, as a blow, riding on horseback upon a 
hard saddle, or by sudden suppression of perspiration, excesses 
in venere, masturbation. 

St condary forms are much more frequent, and are then an ex- 
tension of inflammatory processes from neighboring organs ; 
for example, urethritis, stone in the bladder, gout, rheumatism. 
Its most frequent cause, however, is gonorrhoea, and the abuse 
of irritating medicines, like cubebs, balsam copaiva, turpen- 
tine, etc. 

Symptoms. — Pain in the region of the neck of the bladder ; 



ENLARGEMENT AND TUMORS OF PROSTATA. /27 

heat, pressure, throbbing in the perineum and rectum; frequent 
stitches from the- perineum into the pubic and lumbar regions 
and down into the limbs. Constant desire to urinate, with an- 
noying, sharp pains around the corona glandis; the urine, after 
long straining, flows slowly, drop after drop, a quantity remain- 
ing still in the bladder, and, therefore, micturition is never at- 
tended with a feeling of entire relief. Severe cases cause perfect 
retention of urine. The discharges from the bowels are likewise 
painful and difficult, especially hard stools, on account of the 
swollen and inflamed gland pressing upon the rectum, where it 
may easily be detected by the introduction of a finger per anum. 
In favorable cases prostatitis ends in resolution. Badly-man- 
aged cases suppurate and form abscesses, which perforate, either 
into the rectum, bladder, or urethra, and discharge accordingly. 

THERAPEUTIC HINTS.— Arnica, after injuries. 
Bellad., with severe pain, or 
Atrop. sulph., if Bellad. does not relieve. 
Mercur., for promoting resolution. 

Bellad., Canthar., Hyosc, Strammon., in case of retention 01 
urine. (Kafka.) 

Enlargement and Tumors of the Prostata. 

The gland vaay, in consequence of infiltration or deposition of 
tubercles, or calcareous substances, become in whole or in part 
enlarged. A total hypertrophy may reach the size of a fist or more, 
whilst the normal gland is not larger than a Spanish chestnut; 
it may be so uniform that the normal shape of the gland remains 
unaltered, or it may become quite considerably deformed. Partial 
hypcrtropJiy alters in size and shape only single lobes of the gland. 

As the prostate gland surrounds the urethra, reaching, with 
its base, over the neck of the bladder, and with its anterior ex- 
tremity to the pars membranacea of the urethra, it is obvious 
that an increase of its size or an alteration of its form must like- 
wise modify the mechanical proportions and relations of the 
prostatic portion of the urethra, of the neck of the bladder and 
the ejaculatory ducts. For 'example, an uniform enlargement of 
the gland necessarily pushes the bladder further back and up- 
wards, elongating, in this way, the involved part of the urethra 
quite considerably, which explains the fact, that in old people 



728 PROSTATA. 

sometimes the neck of the bladder is only with difficulty reached 
by the catheter. 

The enlargement of a lateral lobe, or an irregular enlargement 
of both lateral lobes, causes irregularities in the direction of the 
enclosed part of the urethra, compressing it more or less here 
and there, thus forming a kind of zig zag passage. Or the pos- 
terior part of the enlarged lobe presses into the bladder, and thus 
shuts the neck of the bladder inside, or gives it an oblique turn. 

The enlargement of the middle lobe or isthmus, which is the 
deformity most frequently found in old age, is capable of closing 
the neck of the bladder partially or entirely, and preventing the 
passage of urine in part or entirely. 

Symptoms. — An examination per anum reveals the swollen 
gland, and, on introducing a catheter into the urethra, we find 
more or less obstruction in its prostatic portion. There is diffi- 
culty in urinating, which is sometimes possible only in a stooping 
posture with legs spread asunder; dribbling of urine, and frequent 
discharge of prostatic fluid during stool. The form of alvine dis- 
charges is often flat or irregular, instead of being cylindrical. 
Old age is particularly subject to chronic enlargement of this 
gland. 

THERAPEUTIC HINTS, according to Lippe. 

Pulsat, inflammatory origin, painfulness in the region of the 
bladder; frequent desire to urinate; dull stitch in the region of the 
neck of the bladder ; after micturition spasmodic pains in the bladder, 
extending to the pelcis and thighs; feces flat, of small size. 

Thuja, syphilitic origin, especially suppressed, or badly treated gon- 
orrhoea; stitches in the urethra from behind; also from the rec- 
tum into the bladder. 

Digit, fruitless effort to urinate, or discharge of only a few drops 
of urine, and continued fulness after micturition; throbbing pain 
in the region of the neck of the bladder during the straining ef- 
forts to pass the water; increased desire to urinate after a few 
drops have passed, causing the patient to walk about in great 
distress, although motion increases the desire to urinate. Fre- 
quent desire to evacuate the bowels at the same time; very small, 
soft stools are passed without relief. ' 

Cyclam., in and near the anus and in the perinamm, drawing, 
pressing pain, as from subcutaneous ulceration of a small spot, 
while walking or sitting. 



ENLARGEMENT AND TUMORS OF PROSTATA. 729 

Selen., while sitting, and also while walking, a drop of viscid, 
transparent fluid presses out of the urethra, occasioning a pecu- 
liarly disagreeable sensation ; the same sensation is experienced 
shortly before and after stool. 

Caustic, pulsations in the perinseum ; after a few drops have 
passed, pain in the urethra, bladder, and spasms in the rectum 
and renewed desire. 

Lycop., pressing in the perinseum, near the anus, during and 
after micturition; stitches in the neck of the bladder and anus at 
the same time. 

Iodium, hardness of the gland. (Kafka.) 

Copaiva bals., urine is emitted by drops. 

Apis, frequent desire and pressing down in the region of the 
sphincter. 

Discharge of prostatic fluid during a stool: Agnus cast., Alum., 
Anac, Calc. carb., Carb. veg., Conium, Corall., Hepar, Ignat., 
Natr. carb., Sepia, Silic, Staphis., Sulphur, Zincum. 

Fulness in the perinseum: Alum., Berber., Ityron., Cyclam., 
Nux vom. 

Sensation of heaviness in the perinseum : Copaiva, Graphit. 

Pulsation in the perinseum : Caustic. 

Continual desire to urinate: Amm. carb. and mur., Anac, Apis, 
Asar., Aurum, Bellad., Canthar., Colonic, Copaiva, Digit., Guaiac, 
Ignat., Iodium, Mercur., Millef., Mur. ac, Phosphor., Pulsat., 
Sepia, Scilla, Sulphur, Sulph. ac, Thuja. 

Impossibility to urinate : Digit., Sepia. 

The desire to urinate continues after micturition: Bar. carb., 
Bovista, Bryon., Calc. carb., Caustic, Carb. an., Crot. tigl., Digit., 
Guaiac, Laches., Mercur., Natr. carb., Ruta, Sabina, Staphis., Thuja, 
Viol, trie, Zincum. 

While urinating, burning in the region of the neck of the bladder : 
Chamom., Nux vom., Petrol., Sulphur. 

The stream of urine is small: Graphit., Oleand., Nitr. ac, Sar- 
sap., Spongia, Staphis., Sulphur, Tax. bacc, Zincum. 

Difficulty in voiding urine — must press a long time before the urine 
flows: Alum., Apis, Hepar, Naphthal., Secale, Tax. bacc. 

Escape of urine involuntarily, drop by drop: Arnica, Bellad., 
Mur. ac, Digit., Petrol., Pulsat., Sepia. 



730 VESICULiE SEMINALES. 

DISEASES OF THE VESICUL^ SEMINALES. 

The vesiculse are two little, oblong bladders, sometimes divided 
into two or three branches, which lie on the posterior and infe- 
rior surface of the bladder, and consist of an external contractile 
and an internal or mucous membrane. They are receptacles of 
semen, whence the latter is ejaculated during sexual excitement. 
In consequence of their location near the bladder and their func- 
tional relation to the sexual organs, it frequently happens, that 
affections of the bladder, urethra, prostata, and testes are com- 
municated to these vesicles. They are, like all mucous mem- 
branes, prone to inflammation and consequent derangements. 
Their morbid secretions mix with the semen, which loses its 
healthy appearance and nature. A clear diagnosis of such affec- 
tions is seldom possible during life ; although bloody, yellow, in- 
voluntary emissions, attended with acute, cutting, and burning 
pains, may lead us to suspect the existence of inflammation in 
these vesicles. 

Pollutiones Nocturnae et Diurnae ; Spermatorrhoea. 

In as much as the seminal secretion of a healthy man may 
naturally be supposed to be a continuous one, it appears as a 
physiological necessity, that there should occur from time to 
time an overflow of semen involuntarily, when not irritated vol- 
untarily by coition or masturbation. As long as such discbarges 
happen at night during sleep, with erotic dreams, accompanied 
by erections and voluptuous sensations, and followed by a sense 
of relief and buoyancy, these nocturnal pollutions are certainly 
within the boundaries of health. They do not occur regularly 
even in the same individual, but vary greatly in frequency from 
temporary causes, or certain constitutional peculiarities. How- 
ever, if they occur too often, say several times a week or oftener, 
and are followed next day by a general dulness and weakness, 
diminution of mental activity, etc., instead of buoyancy, they can 
scarce^ be looked upon as healthy occurrences. This is still 
more so if they occur without erection and sensation in the night 
during sleep. But if they occur even in the daytime — "diurnal 
pollutions" — while the individual is awake, without the usual 
mechanical causes (coition or masturbation), from any trifling 
external cause; for instance, from dallying with a female, riding 



SPERMATORRHEA. 731 

on horseback, during evacuation of the bowels or bladder, or from 
lascivious imaginations, then there surely exists an irritation 
and weakness in the sexual organs which is pathological ; for a 
healthy man never loses semen involuntarily when awake. Such 
diurnal seminal losses have also been termed Spermatorrhoea a 
rather hyperbolic expression, as a continuous flow of semen 
scarcely ever exists. And it should further be stated, that very 
often inexperienced young men, frightened by reading misera- 
ble and designing trash upon this subject, take for spermator- 
rhoea what is no flow of semen at all, but a secretion from the 
mucous membrane of the urethra, and perhaps also from Cow- 
per's glands, or a prostatic secretion ; neither of which contains 
any trace of spermatozoa, the only sign of true semen. 

The principal Causes of abnormal seminal losses are masturba- 
tion and excessive indulgence in venere. In both ways the frequent 
irritation not only produces an excessive irritability of the sexual 
organs and an undue stimulation for the secretion of semen, but 
also an intensive excitement of the nervous system which by de- 
grees grows into permanent overexcitability, so that ejaculations 
at last are not only provoked by peripheral, but also by central 
stimuli, such as lascivious thoughts, etc. That actual degenera- 
tion of the spinal cord can be produced by sexual excess alone 
is still to be proven. 

Further causes of abnormal seminal losses are : chronic inflam- 
mation of the neck of the bladder and the prostatic portion of the 
urethra, often produced by suppressed gonorrhoea, in consequence 
of which a higher degree of irritability of the parts ensues ; in- 
flammatory affections of the bladder, but especially lythiasis ; chronic 
inflammation of the seminal vesicles, especially when connected with 
gleet ; great length and narrowness of the prepuce, which prevent 
thorough cleansing of the parts from smegma and promote un- 
due irritation ; itching eczema on the scrotum or about the anus; 
habitual constipation and hemorrhoidal tumors. 

The Symptoms which accompany abnormal losses of semen 
are not caused by them, but owe their origin to the same causes 
as produce them. Of these may be mentioned : a hypochondria- 
cal mood, with despair of recovery, a dislike for society, and even 
suicidal thoughts, which are seldom executed for want of cour- 
age; or quarrelsomeness and kritableness ; loss of energy and 
courage, depressed state of mind, impairment of memory ; ver- 
tigo, headache; deafness and noises in the ears; indistinct vision ; 



732 vesicul^; seminales. 

fatigue; stiffness in limbs and back; trembling in limbs; numb- 
ness along the spinal cord, in the lower extremities, or in the 
fingers; or hyperesthesia ; coldness in the back or some other 
part; sometimes alternating with flushes of heat; palpitation, 
and shortness of breath ; indigestion, with consequent disturb- 
ances of nutrition, such as paleness, emaciation, sallowness and 
dryness of skin ; or pasty and bloated appearance; impotence. 

Now, this gloomy picture should not be taken as applying to 
all or even to single cases precisely ; for happily these symptoms 
are only partially constant and severe in cases of abnormal pol- 
lutions. A hypochondriacal mood is perhaps the most common 
of them all. 

The termination of spermatorrhoea into insanity or epilepsy is 
quite unproved. On the contrary a hereditary disposition to in- 
sanity or epilepsy may be in many cases the cause of masturba- 
tion and the consequent spermatorrhoea. 

The Prognosis depends upon its causes. Of these the local ir- 
ritations are relatively the most favorable, while the psychical 
causes are deeper and more difficult to eradicate. 

THERAPEUTIC HINTS.— First rule, stop the cause. This applies 
not only to sexual abuse, but also to those exciting causes above 
mentioned, which ought to be found out by the physician and 
serve as leading symptoms for the selection of the remedy. 

Aur. met. or mur., settled melancholy with suicidal mania ; dis- 
charge of prostatic fluid from a relaxed penis, during stool or 
micturition ; great sexual weakness with great lasciviousness : or 
strong erections which cease on the attempt to copulate ; affec- 
tions of the testicles and spermatic cords. 

Calc. carb., after pollution, headache and backache; cold, clammy 
hands and feet; scrofulous subjects; shattered constitutions; 
sweating from any little exertion, especially on head. 

Cinchona, nocturnal emissions, frequent and debilitating ; las- 
civious fancies ; after masturbation. 

Digitalis or Digitalin., great irritability and weakness of the 
genitals ; after an emission a sensation in the urethra as if some- 
thing were running out of it; frequent palpitation and trembling 
of the limbs; in conversation with strangers he commences to 
stammer and becomes embarrassed. Prostatic troubles. 

Gelsem., weak, irritable sexual organs ; emissions without erec- 
tions, also during stool ; genitals cold and relaxed ; or profuse 



SPERMATORRHEA. 733 

warm sweat on scrotum ; after suppressed gonorrhoea, orchitis, 
with dragging pains in the testicles. 

Graphit, nocturnal emissions, with flaccid penis and without 
voluptuous sensation; sense of weakness in the genital organs; 
herpetic eruption on scrotum ; after sexual abuse. 

Lycop., excessive and exhausting pollutions, also without erec- 
tion : afterwards burning in urethra; itching of inner surface of 
foreskin ; soreness between the scrotum and thigh ; constipation ; 
haemorrhoids. Impotence, with cold and shriveled penis; after 
masturbation. 

Nux vom., after quack -medicine, wine or coffee ; sluggish action 
of abdominal organs ; constipation ; haemorrhoids ; suppressed 
gonorrhoea; masturbation. 

Phosph. ac, debilitating emissions from weakness of the parts, 
with onanism ; during stool ; hypochondriacal ; distressed on ac- 
count of the culpability of his indulgence. Youths who grow 
fast and tall; herpes preputiaiis, with tingling; urine turbid, 
with heavy sediment. 

Sarsap., nocturnal emissions, with lascivious dreams, followed 
by pain from the small of the back clown along the spermatic 
cords, in the morning, with general prostration ; or, great an- 
guish of mind ; inability to apply himself to mental work ; smoky 
mist before the eyes, when reading in the evening; prostration; 
soft, flabby muscles. The least excitement causes ejaculation of 
the fluid without sexual feeling. (J. B. Hunt.) Offensive odor 
about the genitals ; herpes on the prepuce ; gonorrhoea checked 
by cold, wet weather, or by mercury, followed by rheumatism. 

Selen., nocturnal emissions with lascivious dreams, followed by 
weakness and lameness in the loins. (J. F. Greenleaf.) Semen 
thin without normal odor; prostatic fluid oozes while sitting, 
during sleep, when walking and of stool; itching of the scrotum. 

Sine., aching in sacrum; sweat of scrotum ; heat in head; burn- 
ing of feet with sweat; weakness and heaviness of arms; melan- 
choly: all worse in forenoon and before an emission, and relieved 
after an emission. (W. P. Wesselhoeft.) 

Thuja, painful spermatic cord; suppressed gonorrhoea; renewed 
gonorrhoea after coition; prostatic affections; impotence; heavi- 
ness and ill-humor after emissions. 

Zinc, ox., with hypochondriasis, full of fears of the conse- 
quences; nervous system shaken; restless, sleepless and generally 
miserable. 



734 VESICUL^E SEMINALES. 

Besides compare: 

Arnica, when coition has been practiced in a standing position 
lame weakness in lower extremities. 

Bellad., with gleet. 

Capsic, impotence, atrophy and coldness of the genitals. 

Carb. veg., heartburn, acidity and flatulence. 

Caustic, memory deficient; continual loss of prostatic fluid. 

Cuprum., great nervousness of young men, prematurely old; 
cramps in the calves of the legs and feet on trying to have a con- 
nection with a woman. 

Dioscorea. 

Kali brom., want of sexual instinct. 

Kobaltum, lewd dreams ; only partial or no erections. 

Mercur., after emission burning pain in back and icy cold hands. 

Natr. mur., poor digestion and spinal irritation. 

Nuphar., lascivious thoughts without sexual capacity. 

Phosphor., nervous prostration ; oppression and pain in chest ; 
paralytic or spasmodic symptoms in extremities. 

Picric acid. 

Sepia, ejaculation too soon ; semen watery; catarrhal affections ; 
bloated and earthy colored face. 

Sulphur, erection complete, but discharge of semen before he 
succeeds in inserting the penis. 

Bloody emissions: Mercur., Cannab., Ledum, Sarsap. 

Impotence ; Sterility in the Male. 

Impotence, a diminution or complete loss of the power of sexual 
intercourse, is always associated with either incomplete, or too 
short, or entirely absent erections. It may be Caused by: certain 
congenital or acquired mat [format ions and defects of the genital organs, 
such as : absence of the penis, or considerable diminution in its 
length, tumors of the penis, indurations and knots in the corpora 
cavernosa, loss of the testicles either by castration (although cases 
are on record which show that the sexual act could be accom- 
plished after castration, this quasi virile power, however, dimin- 
ished more or less speedily and finally disappeared entirely), or 
such disease as is equivalent to their loss. It may be a symptom 
of certain acute or chronic diseases, such as: tabes dorsales, spinal 
meningitis, diabetes ; or the consequence of certain medicines, if 
taken in too large doses and indiscriminately, among which are 



IMPOTENCE. 735 

best known : Camphor, bromide of potassium, lupuline, and ar- 
senicum. It may be produced by certain mental conditions, such 
as : bashful ness, fear of failure, nervousness, or the absence of cer- 
tain modes and ways to which they have become habituated with 
prostitutes and which they cannot indulge in with their wives. 

A very prominent cause is sexual excess and masturbation, by 
which a functional weakness of the genital organs and of the 
nervous apparatus connected with them is brought about, in 
consequence of which only short erections, too short even for the 
introduction of the penis, so-called irritable tveakness, or no erec- 
tions at all, are possible under any circumstances, the so-called 
paralytic form of impotence. 

A man impotent is also sterile, that is unable to procreate, even 
if his semen should be of a natural quality, because he cannot 
locate it where alone it could fructify. But sterility has other 
causes, which are: 

1. Aspermatism, which means not only a variety of conditions 
in which no semen is formed (as certain malformation or injuries 
of the genital organs, absence or malposition of the testes), but 
also those conditions in which the formed semen is not ejaculated, 
because its passage is barred by changes in the substance of the 
prostate, or in the ejaculatory ducts embedded in it, or in the 
urethra, from whence it is diverted into the bladder. The 
causes of this retention of semen are strictures in different places 
in the seminal passages produced by inflammatory processes 
mostly in consequence of gonorrhoea, or wounds, or they are 
congenital. 

2. Azoospermism, in which copulation with ejaculation may be 
possible, but in which either no seminal bodies are produced, on ac- 
count of an abnormal state of the testicles, or in which they are 
retained on account of strictures in the passages which conduct 
the semen, in consequence of bilateral inflammatory processes of the 
epididymis and vasa deferentia, a condition similar to aspermatism, 
only that in the latter the stricture is lower down in the genital 
passages. 

THERAPEUTIC HINTS.— Compare the preceding chapter, espe- 
cially in regard to those transient forms: Agar., Agn. cast., Baryta, 
Calad., Lycop., Natr. mur., Nitr. ac, Selen. 

Among the new remedies: Eupat. pur., Gelsem., Hamam., 
Helon., Phytol., Stilling. 



736 FEMALE GENITALS. 



FEMALE GENITAL ORGANS. 



Examination of the Parts. 

By means of palpation and percussion of the abdomen we may 
be able to detect the presence, shape and consistence of abdomi- 
nal tumors, and auscultation will serve to distinguish between 
pregnancy and other large tumors ; the so-called uterine scuffle, 
which originates in the large arteries, is heard, not very seldom, 
in large fibroids, and also, but rarely, in ovarian tumors. 

The digital examination per vaginam consists of the introduction 
of the well-oiled forefinger through the ostium into the vagina, by 
which we ascertain the condition of the walls of the vagina, 
Avhether they are dry, moist, sensitive, encumbered by protrusions 
of the rectum or bladder, or by morbid growths, etc.; the state of 
the anterior and posterior cul-de-sac; the position and condition 
of the cervix and os uteri and of the lower part of the Avomb. In 
cases of vaginal occlusion or hyperesthesia, but especially in all 
kinds of retro-uterine tumors, a digital exploration per rectum is 
the most valuable aid for diagnosis. 

The bimanual examination consists in an exploration by means 
of the one hand through the abdominal walls, while the forefinger 
of the other hand within the vagina rests on the neck of the 
womb. In this way the entire organ may be brought between 
the exploring fingers of both hands, so that its shape, consistence 
and mobility, etc., or the existence of any tumor within the true 
pelvis can easily be ascertained. This conjoined method of exami- 
nation, as it is likewise termed, is best performed in the dorsal 
position on an unyielding couch. Care should be taken that the 
outside hand is only slowly pressed into the abdominal wall above 
the symphysis pubis, which is best done by taking advantage of 
each expiration; and by inserting the hand not too close to the 
symphysis, in order to avoid the pushing backward of the uterus. 

Examination by means of the uterine sound (of which those 
most in use are the steel, Simpson's and Skene's sounds) consists in 
the introduction of a curved metallic instrument into the cavity of 
the womb, guided by the forefinger which has been inserted into 
the vagina. This exploration gives a measurement of the length 
of the uterine cavity, discloses the course taken by it and the 



OOPHORITIS, OVARITIS. 737 

sensitiveness of its walls and tells whether the uterus is empty or 
not. This sort of examination should never be resorted to so 
long as there exists the slightest doubt as to tbe possibility of 
pregnancy. 

Ocular examination is assisted by vaginal specula in order to 
bring the os and cervix uteri into view. There are bi valvular, 
trivalvular and tubular specula, of which those most in use are 
Cosco's or Wocher's bivalve, Nelson's trivalve and Furguson's or 
Mayer's tubular speculum, all of course of different sizes. For the 
better viewing of the posterior wall of the vagina we have Sim's 
duckbill, also his folding speculum and Dawson-Sim's improved 
speculum, instruments which the specialist may need for certain 
operations. 

There are undoubtedly cases where an examination by either 
of these means may be absolutely necessary. But it is certainly 
beyond the lines of even medical decency to subject every woman 
who shows any signs of uterine disturbances at once to digital or 
ocular examination, especially if that woman be a virgin. It is 
a curse of vanity to show one's ability to handle or mishandle 
an instrument at the expense of an innocent or inexperienced 
person, and it is the highest degree of ignorance to look or feel 
for something what by better information we would not expect to 
find there, or what we should know to find without fingering. It 
is therefore not to be wondered at that thoughtful medical gen- 
tlemen have condemned the use of these physical examinations 
almost in toto. Almost — for the helping hand and the seeing eye 
will even here be needed in certain cases as anvwhere else. 



OVARIES. 

Oophoritis, Ovaritis. 

This affection has its seat either in the parenchyma (the Graa- 
fian follicles), or in the connective tissue, or in the peritoneal cover- 
ing of the ovary. 

If in the glandular part (parenchyma) the mature Graafian fol- 
licles have a milky turbidity and the cells of the membrana 
granulosa are in a state of cloudy swelling and subsequently break 
down into fine granules, the layer of the stroma surrounding 
the follicle is likewise inflamed. This form of inflammation oc- 
curs frequently in acute febrile diseases in which we also meet 

47 



738 OVARIES. 

with parenchymatous inflammations of other abdominal glands ; 
it may cause destruction of all the follicles and so result in sterility. 

If in the connective tissue there is hyperemia, swelling and in- 
filtration of this tissue which may terminate in the formation of 
abscesses, generally, however, results in cicatricial shrinking with 
consequent sterility. It is most frequently found in the puerperal 
period, or as an extension of a peritonitis, and in consequence of 
suppression of the menses. 

If in the peritoneal covering (Perioophoritis) it leads to pseudo- 
membranous deposits upon the ovary, and to adhesions with 
neighboring organs. Its Causes are: taking cold; getting wet 
during menstruation ; sexual intercourse during the menstrual 
period ; onanism ; or, secondarily, inflammatory processes of 
neighboring organs — the peritoneum, or the uterus ; gonorrhoea. 
It is therefore most frequently found in serving girls, who are ex- 
posed to all kinds of rough influences, (scrubbing of pavements, 
washing, etc.,) in prostitutes, and other lewd women. Girls who 
have once had an attack are liable to a repetition during their 
menstrual periods. After the cessation of menstruation, the dis- 
position to it ceases likewise. 

Its Symptoms are not at all well-marked, when the connective 
tissue alone is the seat of the disease. We meet with symptoms 
of partial peritonitis, however, if the serous covering becomes in- 
flamed; violent, sharp, colicky pains, vomiting, fever, etc.: and 
so also may the bursting of a Graafian follicle be attended with 
inflammatory symptoms. As the ovaries lie deep in the lesser 
pelvis, covered completely by the small intestines, pressure down- 
wards, irom above the symphysis pubis, will reach the sore spot 
only when the abdominal walls are greatly relaxed. Bimanual 
examination or an exploration per anum may become necessary 
in chronic cases. "We may, however, diagnosticate an acute attack 
pretty safely when the above-mentioned symptoms have set in dur- 
ing menstruation, after an exposure to cold or wet. followed by a 
sudden cessation of the menstrual flow. Where the inflamma- 
tion spreads over adjoining organs, we find it accompanied by 
painful urging to urinate and to evacuate the bowels ; by utero- 
vaginal blennorrheas, or a numbness in the lower extremity of 
the affected side. 

An acute attack rarely lasts longer than eight days, generally 
subsiding within twelve to twenty-four hours. In unfavorable 
cases it becomes chronic, and may terminate in the formation of 
serous cysts, induration of the ovary, or in suppuration. 



OOPHORITIS, OVARITIS. 739 

THERAPEUTIC HINTS.— Aeon., headache, backache, colic, fever, 
great restlessness and tossing about ; after exposure to cold winds 
or a sudden fright during the monthly period, by which the flow 
ceases ; painful urging to urinate and to evacuate the bowels. 

Ant. cruel., when menstruation has been checked by taking a 
bath ; nausea and vomiting, white tongue ; great thirst at night ; 
alternate costiveness and diarrhoea. 

Apis,- right side ; swelling, with stinging pains from sexual in- 
tercourse during the monthly period; numbness in the right 
side of the abdomen, extending into the thigh, or upwards to the 
ribs; scanty urine; retarded stool"; cough, with soreness in the 
upper portion of the left chest. 

Arsen., drawing, stitching pain from the region of the ovary 
into the thigh, which feels numb and lame, worse from motion, 
bending or sitting bent ; burning pain in the back while lying 
quietly upon it ; the menses consist of a thin, whitish, badly- 
smelling discharge ; pale, yellowish face ; emaciation ; febrile 
action ; thirst, with drinking little at a time ; restlessness. 

Bellad., hard swelling of the ovary, with stitching, throbbing 
pains; constant bearing down, as if everything would issue out; 
fever, with perspiration; glistening eyes; red face and delirium; 
after child-birth. 

Bryon., stitching pain, Avorse from the slightest motion and 
contact; suppression of the menses, with bleeding of the nose; 
inclined to constipation. 

Canthar., stitches, arresting the breathing; or violent pinching, 
pains, with bearing down towards the genitals ; or great burning 
pain in the ovarian region; constant urging and straining to 
urinate, with painful discharge of but a few drops of urine, which 
sometimes is bloody; after suppressed gonorrhoea. 

Coloc, cramp-like pain in the left ovarian region, as though the 
part were squeezed in a vice; colicky pain all over the abdomen, 
which causes the patient to bend double; pain in the left foot; 
worse before menstruation, which is more profuse. 

Conium, chronic cases; induration; lancinating pains; pain in 
the mammae before the menses, which are feeble ; smarting, ex- 
coriating leucorrhcea; giddiness when turning in bed; intermit- 
ting flow of urine. 

Hamam., after a blow, the ovary swollen, with a diffuse agoniz- 
ing soreness over the whole abdomen; menses irregular, very 
painful, with exacerbation of all the sufferings at the catamenial 
epoch ; retention of urine. 



740 OVARIES. 

Hepar, when suppuration takes place, indicated by frequent 
crawls. 

Ignat, disappointed love; constant running of thoughts in that 
direction; sighing, despondency; leucorrhoea which passes off 
with labor-like pains. 

Iodium, when indurated. 

Laches., left ovary; tensive, pressing pains and stitches; ina- 
bility to lie on the right side on account of a sensation as if 
.something were rolling over to that side; menses scanty, with 
labor-like pressure from the loins downward; swelling of the 
ovary; suppuration. 

Mercur., stitching, pressive pains in the lower region of the 
abdomen, left side; upper portion of the abdomen distended; 
stool with great tenesmus; constant urging to urinate, with 
scanty emission of a thick, brown-fed urine, causing burning in 
the urethra; perspiration without relief; great weakness and 
emaciation; nightly aggravation and restlessness; menses sup- 
pressed. 

Nux vom., after previous use of different allopathic drugs. 

Platina, excessive sexual desire, from an incessant tickling 
within the genitals ; painful pressing towards the genital organs, 
as if the menses would make their appearance ; profuse or sup- 
pressed menses, with palpitation of the heart, headache, restless- 
ness and weeping ; haughtiness. 

Pulsat, after getting the feet wet ; suppression of the menses, 
with nausea, coldness of the body, chilliness and trembling of 
the feet ; pressure on bladder and rectum ; thirstlessness, weep- 
ing, meek disposition. 

Rhus tox., after getting wet, straining or lifting. 

Zincum, boring pain, relieved by pressure and during the men- 
strual flow. 

Compare Aurum, China, Clemat., Hedeoma, Iodium, Phosph. 
ac, Phytol., Podoph., Sabina, Sepia, Staphis., Thuja. 

Hydrops Ovarii, Ovarian Dropsy ; Formation of Cysts in 
the Ovaries. 

Most of these cysts originate, according to some authors, out of 
a degeneration of the Graafian follicles, which become distended, in 
rare cases, even to the size of a child's head ; containing a clear, 
yellowish, serous, or thick, limpid fluid. There may be one or 
several of such cysts. 



OVARIAN DROPSY. 741 

The multlloeular tumors consist of a formation of multiple-cysts, 
growing out of the parenchyma of the ovaries. They sometimes 
attain an enormous size, and contain either a serous or jelly-like 
fluid, which is dark if mixed with blood. 

The alveolar degeneration of the ovary destroys all the original 
structure of that organ ; its whole substance becomes transformed 
into larger and smaller cavities, which are separated by a fine 
tissue. Some of these cavities attain the size of a fist, while others 
remain quite small. At first the organ retains its roundish shape ; 
later, by the extension of some of these cavities, it becomes un- 
even. The contents of these cavities is mostly a yellowish, tough, 
honey-like substance, though the larger ones sometimes contain 
a thinner fluid. This degeneration is often complicated with 
cancer of the ovaries. 

There are yet cysts to be mentioned which, instead of a fluid, 
contain hair, teeth and hones; their interior walls present a struc- 
ture which is quite similar to that of the cutis, having an epi- 
dermis with sudorific and sebaceous glands, and sometimes a 
hairy growth. Such cysts are called dermoid cysts; they some- 
times attain the size of a walnut, or even a fist. They are, per- 
haps, products of ovarian conception. 

There are also fibrous, cartilaginous and osseous tumors of the 
ovary which, like the purely cystic, may be the consequence of 
subacute inflammatory action in these organs. 

The Symptoms of ovarian cysts, in the first stage, may be ident- 
ical with those of an oophoritis ; but usually all such signs are 
wanting, and the cysts, as long as they remain small, give no in- 
convenience whatever. When attaining a certain size, however, 
they exercise a pressure upon the bladder and the rectum, caus- 
ing difficulties in micturition and defecation. When pressing 
upon the nerves, which run down on the posterior wall of the 
lesser pelvis, they cause pain in the small of the back, or pain and 
numbness in the lower extremities ; and when pressing upon the 
veins in the pelvis, they cause oedematous or varicose swellings 
on the lower extremities. At the same time we observe, in some 
cases, a swelling of the mammae and a darkening of the rings 
around the nipples, with sympathetic vomiting and general ma- 
laise, thus simulating very closely the commencement of preg- 
nancy. When the cj'sts grow further, they rise out of the pelvic 
cavity, and most generally the patient feels relieved of those 
symptoms which are caused by their pressure upon the pelvic 



742 OVARIES. 

organs ; in some cases, however, all these symptoms continue, as 
the cysts or portions of them within the pelvic cavity still con- 
tinue to exercise the same compression upon the pelvic organs. 

Increasing still more, they gradually fill the abdominal cavity, 
press against the diaphragm and compress the abdominal organs ; 
the natural consequences of which are: vomiting, shortness of 
breath, palpitation of the heart, bronchial catarrh, disturbed 
secretion of urine, deficient nutrition, and consequently anaemia 
and hydrsemia, which ends in general marasmus. 

Their growth is not a steady one ; they are frequently observed 
to increase and decrease in size periodically; the first taking 
place generally before and the latter after menstruation. As 
frequently intervening symptoms may be mentioned those of 
peritonitis, which are the more severe the more rapidly the cysts 
grow. If a cyst bursts, either by its own excessive distention, or 
by external violence, its contents issue into the abdominal cavity 
and cause a general peritonitis; or it may, in consequence of 
previously formed adhesions and inflammatory processes, find its 
way into another of the abdominal organs, and be thence dis- 
charged. 

Physical Signs. — As long as the tumor remains in the true 
pelvis, it may be diagnosed by an examination per vaginam or 
rectum, where it is felt as a well-defined swelling, which dislo- 
cates the uterus in one or another direction, according to its 
position. The less the tumor takes part in the motions of the 
uterus the more sure is its diagnosis. 

When the tumor rises out of the true pelvis there appears a 
painless, well-defined swelling over the horizontal ramus of the 
pelvic bones; later it inclines more towards the middle-line of 
the abdomen, and yields more or less, a sense of fluctuation ; the 
distended abdomen appears arched and changes its form scarcely 
any during different positions of the body. 

Percussion gives a complete flat sound, where the tumor touches 
the parietal walls, being dullest where the swelling is most promi- 
nent; thus it differs from ascites, which gives a full sound, 
where the distended abdominal walls appear highest; for under- 
neath that place lie, in ascites, inflated intestines; and further- 
more, the fluctuation of a cystic tumor never extends further 
than that portion of the abdomen which yields a flat percussion 
sound, because the fluid is confined in a sac. while in ascites the 
fluctuation is felt also where there is no flat percussion sound, 



OVARIAN DROPSY. 743 

because the fluid is driven further on within the peritoneal 
cavity by the concussion of the palpating hand. 

THERAPEUTIC HINTS.— Compare Oophoritis and Peritonitis. 

Apis, sudden stitches, like bee-stings, in the tumor, or sharp, 
cutting pains, with scanty urine and constipation; bearing down, 
and pain in the small of the back, as if the menses would come 
on; numbness of the corresponding lower extremity; thirstless- 
ness; pale skin; oedema; right side. 

Arsen., burning pain; restlessness; anxiety; oppression; sink- 
ing of strength; great thirst, but little drinking at a time; drop- 
sical swelling all over; pain in the corresponding leg; cannot 
keep the foot still. 

Calc. carb., distention and hardness of the abdomen; pressure 
in the rectum, and bearing down in the womb ; profuse and too 
early menses. 

Canthar., burning pain ; great sensitiveness of the abdominal 
walls; constant, painful urging to urinate and defecate; tenesmus 
in the bladder and rectum ; wretched, sickly appearance. 

China, after great loss of fluids; general anasarca; meteorism. 

Coloc, a firm, elastic tumor occupies the space between the 
uterus and the vagina anteriorly and the rectum posteriorly, 
completely occluding the vagina and rendering defecation very 
difficult. Paroxysms of acute pain across the hypogastrium. in 
the sacral region and around the hip-joint when attempting to 
walk; the pain extends down the groin and along the femoral 
nerve; it is relieved by flexing the thigh upon the pelvis and 
always induced or aggravated by extending the thigh; but there 
are frequent and severe paroxysms without any provocation. (C. 
Dunham.) 

Iodhim, pressing, bearing down towards the genitals; constipa- 
tion; acrid leucorrhcea, corroding the linen; dwindling and fall- 
ing away of the mammae; strumous constitution. 

Lil. tigr., bearing down in the uterine region, worse walking, 
better holding up the abdomen with the hands; tenderness of the 
swollen left ovary; stinging, burning pains from ovary up into 
the abdomen and down the thigh; shooting pains from left 
ovary across the pubes; urine causes a smarting sensation; pro- 
lapsed and sensitive uterus. (E. A. Farrington.) 

Lycop., painful boring stitches in the left ovarian region: 
pressure on the rectum and bladder; pain in the sacral region, 



744 UTEKUS. 

especially when rising from a seat ; red, sand}- sediment in the 
urine ; ascites ; varicose veins on the legs. 

Plumbum, the patient wants to stretch the upper and lower 
limbs during ovarian pains. (Dr. Young.) 

Podoph., tumor on right side; pain and numbness extending 
down the corresponding thigh. (Hawley.) Pains extend upward 
to the shoulder. (Seward.) 

Stramon., tumor attended with some lancinating pains and 
hysterical convulsions. During the convulsions the patient 
shrinks back with fear on seeing any one. (Miller.) 

In cases where proper homoeopathic treatment fails to show 
any influence in staying the growth of such tumors, or in im- 
proving the general health of the patient, operative surgery (tap- 
ping with subsequent iodine injections, electrolysis, ovariotomy) 
is indicated. 



UTERUS. 
Endometritis, Catarrh of the Uterus, Leucorrhoea. 

Always at the time of the catamenial period the mucous mem- 
brane of the uterus is found in a hypenomic state, its overfilled 
blood-vessels burst and ocoasion what is called the menstrual 
flow; this normal hyperemia might be called the physiological 
catarrh of the uterus. It becomes pathological when it occurs at 
a time when no ripe ovula are cast off. A predisposition to uter- 
ine catarrh lies, therefore, between the time when menstruation 
begins until it ceases. 

Exciting Causes are, all such disorders as cause a stagnation 
in ili< proper circulation of the blood, as heart and lung diseases: 
chronic constipation, etc.; direct irritations, such as sexual ex- 
cesses, masturbation, pessaries, etc. ; or a general weakness of the 
system and general morbid conditions, such as typhus, cholera, 
small-pox and other infectious diseases: chlorosis; scrofulosis: 
tuberculosis, etc. 

Its Pathological features are like those of any other catarrh: 
hyperemia, swelling, dryness at first, and afterwards increased 
secretion of mucus. When becoming chronic, the mucous mem- 
brane thickens and hypertrophies, and is sometimes studded with 
polypous excrescences; its color turns brownish or slate-colored: 
the secretion attains a more or less purulent character; the folli- 



CATARRH OF THE UTERUS, LEUCORRHCEA. 745 

cles of the portio vaginalis swell on account of the closure of 
their excretory ducts, while their secretion inside is still going 
on; they form little round bodies of the size of a hemp-seed or 
larger, and are known under the name of ovula Nabothi. Fur- 
thermore, we find, if the process lasts long enough, diffuse catarrhal 
erosions, mostly on the posterior lip of the mouth of the womb; 
or follicular ulcers, which originate in the bursting and suppura- 
tion of the above-named ovula Nabothi; and also granulating 
ulcers, which differ from the rest by their exuberant granulations, 
which bleed easily. 

Symptoms. — An acute attack is characterized by drawing pain 
in the small of the back and in the inguinal region, a feeling of 
fulness and heaviness in the pelvis, dysuria and tenesmus. Ex- 
ternal pressure upon the lower part of the abdomen is painful. 
There is more or less fever. After three or four days the patient 
observes a discharge from the genitals, which at first is transpar- 
ent and sticky, staining the linen grayish; by and by it becomes 
opaque and more or less purulent. In the further course of 
eight or ten days the fever gradually subsides, and after that the 
discharge diminishes until it finally ceases. 

In chronic cases, the commencement is not easily ascertained. 
The patients have had, long before they attach much importance 
to it, a discharge from the womb, which varies considerably in 
different cases. Still it is of the same nature as that above-men- 
tioned, staining the linen grayish, and making it stiff; some- 
times, even, clots of a gelatinous mass issue forth. That is char- 
acteristic of a uterine catarrh. A purulent discharge is just as 
liable to have its source in the vagina ; and if the discharge be 
corrosive, the presumption is that it originates there. In some 
cases, the os uteri closes, owing to the sticky discharge and the 
swollen state of the neck of the uterus ; and, in consequence, a 
collection of large masses of mucus within the uterus takes place, 
which are finally expelled by labor-like contractions of the uterus 
— uterine colic. The longer the catarrh exists, the more it changes 
the mucous lining of this organ, and the greater, of course, must 
be its effect upon the monthly period. In some cases, the flow is 
very profuse, and in others, very scanty ; almost always it is at- 
tended with more or less pain. Conception is not necessarily 
prevented, if the catarrh does not extend to the tubes or causes 
them to be closed ; but it has been observed that women suffer- 
ing with chronic uterine catarrh are very prone to miscarry. A 



746 UTEEUS. 

chronic uterine catarrh may be endured for a long time ; but it 
finally betrays itself by paleness and an earthy color of the face, 
weakness and relaxation of the muscles, anaemia and hydremia. 
The most frequent expressions of chronic uterine catarrh are hy- 
peresthesia, neuralgic and spasmodic complaints; all of which 
we find united under the popular expression of hysteria. The 
progress of the disease is always slow; and among its complica- 
tions we find a chronic parenchymatous metritis, inflections of 
the uterus, and closure of the cervical canal of this organ, which 
results in bydrometra. 

In regard to the diagnosis of the various leucorrhceal discharges, 
the following may be said : 

Watery discharges appear during the greater part of pregnancy, 
without being injurious to the foetus; also in connection with 
hydatid moles, where, after a certain time, moderate discharges 
repeat themselves off and on, accompanied by bearing-down 
pains; in connection with cauliflower excrescences, where the 
serous discharges are often quite copious and of a brown color ; 
in connection with uterine polypi, where the watery discharges 
alternate with bloody ones, and profuse menstruation ; in con- 
nection with adhesion of an ovarian cyst to the Fallopian tube, where 
the fluid of the cyst enters the tube and discharges slowly through 
the vagina. 

Mucous or purulent discharges are more or less opaque, gluey or 
gelatinous, creamy or quite fluid. They all arise from the mucous 
membrane either of the neck of the womb, or of the uterine rarity, or 
of the vagina, or of the three combined. The discharge from the 
cervix is gluey, creamy and more profuse; from the womb it 
looks soapy or like glassy pieces of coagulated mucus : from the 
vagina it is coagulated, has an acrid reaction and contains tes- 
selated epithelium. 

Continuous purulent discharges originate in the vaginal mucous 
membrane, in the cervical glands of the uterus, on the surface of 
a cancerous or other ulcer, in suppurating membranes remaining 
after an abortion, in retained placenta or membranes. Gonor- 
rhceic discharges are also continuous and often difficult to diag- 
nose from leucorrhcea, if the history is wanting. 

Interrupted purulent discbarges take their origin in the uterine 
cavity, in suppurating polypi, in abscesses seated in the neigh- 
borhood of the vagina. 

Sanious discharges consist of a reddish, bloody fluid, arising 



CATARRH OF THE UTERUS, LEUCORRHCEA. 747 

from tumors inside of the uterine cavity, from organic diseases 
of the uterus, such as fungoid degeneration of the uterine mucous 
membrane, malignant ulceration of the os, from pelvic lucmato- 
cele, when a communication exists between cyst and vagina. 

Foul smelling discharges occur where the leucorrhcea is profuse 
and purulent, accompanied by hectic fever and general loss of 
strength, and where the secretion is retained for some time in 
the vagina by a contraction of the ostium vaginal. In uterine 
cancer the discharge is always fetid. 

In giving THERAPEUTIC HINTS, I shall unite both uterine as 
well as vaginal catarrh. Both are known under the popular 
name, leucorrhoea or whites, as the most prominent and some- 
times the only symptom of the two. 

iEsc. hipp., pain in the small of the back and hip, with a lame 
feeling ; the pain extends from the abdomen to the small of the 
back, which makes it almost impossible to get up and to walk 
after sitting ; constipation and piles. 

Alet. far., in cases of debility from protracted illness, loss of 
fluids, defective nutrition, etc.; great disposition to abortion. 

Alum., profuse, purulent, yellow, corroding discharge, worse be- 
fore and after the menses ; during the day only ; vertigo ; con- 
stitution. 

Ambra, discharge only at night; thick mucus with stitches in 
the vagina before the discharge; pieces of bluish-white mucus. 

Amm. carb., watery, burning discharge from the uterus; profuse, 
acrid or milky leucorrhoea; menses every fortnight, black, coagu- 
lated, profuse; weight in stomach; urine reddish; flow often 
interrupted; flushes. 

Amm. mur., leucorrhcea with distention of the abdomen, without 
accumulation of wind; discharge like the white of an egg, after 
previous pinching around the navel; brown, slimy, painless leu- 
corrhoea, after every discharge of urine; stools hard, crumbling. 

Aralia rac, offensive discharge, with pressing-down pains in the 
uterus. 

Arsen.. discharge, dropping out while standing, and passing 
flatus; burning, corroding; weak persons; old women; nervous 
restlessness. 

Aur. met. and mar., chronic metritis with malposition ; indura- 
tion; excoriation, with great sensitiveness of vagina; utter 
despair. 



748 UTERUS. 

Bapt. tinct, acrid, fetid discharges; ulceration of the os uteri 
and vagina; debilitated state of the system. 

Bellad., acute catarrh ; bearing down as if all the contents of the 
abdomen would issue through the genitals, which is followed by 
a discharge of white mucus; colicky pains coming and going 
suddenly. 

Berber., burning and smarting after micturition, with a con- 
stant soreness along the urethra. (F. Baker.) 

Borax, midway between the menses; albuminous discharge; 
cannot bear downward motion. 

Bovista, after the catamenia ; while walking, thick, slimy, tena- 
cious mucus, like the white of an egg; also yellow, green, acrid, 
corrosive ; during the night only. 

Calc. carb., milk-like discharge during micturition, or flowing 
profusely only in spells; or purulent discharge with soreness and 
swelling of the vulva; too early and too profuse menstruation; 
paleness of the face; weak feeling in the chest, especially when 
talking; weakness in the knees; emaciation; constant cold, damp 
feet. 

Carb. veg., discharge only in the morning, when rising; soreness 
and rawness in the pudendum; cold knees in bed; flatulence. 

Cauloph., profuse secretion of mucus in the vagina; yellowish 
spot on the forehead, commonly called "moth"; bearing down 
with tardy or absent menses; drawing pains in lower extremities. 

Caustic, weakening leucorrhoea, with too scanty or too profuse 
menses; discharge, particularly at night ; yellow face; disinclina- 
tion to coitus. 

China, leucorrhoea instead of the menses; painful pressing to- 
Avards the groins and anus; bloody discharge, occasionally clots 
of black blood; or fetid, purulent matter, with itching and spas- 
modic contraction of the inner parts ; great weakness from loss of 
blood. 

Coccul., flesh-colored, watery discharge, instead of the menses, 
mixed with a purulent and ichorous liquid; on bending or squat- 
ting down, the fluid gushes out; distention of the abdomen and 
pain, as of a heavy stone; on sitting down, bending, treading or 
any other motion, a pain, as of internal ulceration; great debility. 

Collins., leucorrhoea in connection with pruritus, obstinate con- 
stipation and dysmenorrhea, 

Conium, white discharge, burning, smarting, excoriating: sup- 
pression of the menses; itching at the vulva: contractive, labor- 



CATARRH OF THE UTERUS, LEUCORRHOEA. 749 

like colic, from both sides of the abdomen; weakness and lame- 
ness in the small of the back and subsequent lassitude; old 
maids; hysteric paroxysms; swelling and induration of glands. 

Ferrum, in chlorotic patients, thin, watery discharge, at first 
smarting and corroding; palpitation of the heart; earthy, yel- 
lowish face; painfulness of the vagina during an embrace; swell- 
ings and indurations in the vagina. 

Gelsem., white discharge; feeling of fulness in the hypogas- 
trium; aching across the sacrum. 

Graphit., perfectly white discharge, very profuse, especially in 
the morning on rising from bed, also in gushes by day or night; 
scanty menses; irritable skin; weakness in the back and small of 
the back, when walking or sitting. 

Hamam., especially in those profuse discharges which simulate 
a haemorrhage and constitute a drain on the system as severe as 
a bleeding; soreness of the abdomen. 

Helon. has been recommended in cases of general atony, anae- 
mia and torpid condition of the system. 

Hydrast, tenacious discharge; erosions and superficial ulcera- 
tion of the cervix uteri and vagina; great sinking and prostra- 
tion at the epigastrium, with violent and continued palpitation 
of the heart. 

Ignat, violent, crampy pressing in the region of the womb, re- 
sembling labor-like pains, followed by a purulent, corrosive dis- 
charge; mild dispositions who bear sufferings, even outrages, 
without complaining. 

Iodium, old leucorrhcea, most abundant at the time of the 
menses, rendering the thighs sore and corroding the linen; 
dwindling and falling away of the mammae; goitre; induration 
of cervix and womb. 

Kreosot., leucorrhcea before and after the menses, especially 
when standing and walking, not when lying or sitting; the yel- 
low discharge is acrid and corroding, offensive, causing redness 
and itching in the vulva; menses too early, too profuse and too 
long. 

Laches., leucorrhcea before the menses, copious, smarting, slimy, 
stiffening and staining the linen greenish; the menses appear at 
the regular time, but are too short and too feeble; the abdomen 
is hot and tender to touch ; feels bad after sleeping. 

Lil. tigr., abundant, thin, excoriating discharge, staining the 
linen brown, worse p.m.; bearing down relieved in lying down or 



750 UTERUS. 

sitting, or pressing with the hand against the'parts; frequent mic- 
turition with smarting or burning in urethra afterwards; depres- 
sion of spirits ; pain, distress and fluttering of heart ; menses flow 
as long as she keeps moving; sometimes come on too early and 
are scanty; depression of spirits: feels all the time in a hurry 
without accomplishing anything. 

Lycop., profuse, greenish, thick discharge, not constantly hut in 
spells, which are always preceded by a sharp cutting pain in the 
hypogastrium ; pale face, with frequent flushes of circumscribed 
redness of the cheeks; discharge of wind from the vagina; the 
least quantity of food fills her up to the throat; jerking of the 
lower extremities. 

Magn. mur., early in the morning after urinating and after stool ', 
constipation. 

Mercur., inflammation of the genitals; discharge of various 
nature, always worse at night; gonorrhoea; syphilis. 

Murex purp., watery, greenish or thick bloody discharge; pro- 
fuse and too early menses; increased sexual desire. 

Natr. mur., leucorrhceal discharge after contractive colic, press- 
ing downwards, early in the morning, at night, when walking; 
itching and soreness of the genitals; cutting pain in the urethra 
after micturition; yellowness of the face; and especially after 
local applications of nitrate of silver. 

Nitr. ac, mucus — which can be drawn out — flesh-colored, green- 
ish, cherry-brown, fetid; after mercurial treatment. 

Nux vom., fetid discharge, tinging the linen yellow; after all 
sorts of allopathic nostrums. 

Pallad., pain in right ovary; urgency to urinate with scanty 
emission, and sensation of weight and bearing down in pelvis, 
relieved by lying down; prolapsus uteri; forgets every pain in 
society, but is worse next day; attaches great weight to other 
people's opinions; likes to be flattered. 

Phosphor., in consequence of chlorosis; watery slime, especially 
during or instead of the menses; acrid, smarting, corrosive, 
drawing blisters. 

Platina, during daytime; genitals excessively sensitive: can't 
bear to be touched; will go into spasms from an examination ; 
will almost faint during intercourse; or excessive sexual desire; 
haughty disposition, or low-spirited. 

Podoph, discharge of thick, transparent mucus, attended with 
constipation and bearing down in the genitals; prolapsus uteri 
and ani. 



PARENCHYMATOUS METRITIS. 751 

Pulsat, burning discharge, thin and acrid, milky, thick and 
white, without pain; when lying, or before and during the 
menses, which are scanty; inclination to looseness of the bowels; 
chilliness; thirstlessness; peevishness; sadness; mild and tearful. 

Sepia, in the climacteric period; during pregnancy; during 
puberty, when there is a sense of pressure and bearing down in 
the pelvis, stinging pain in the ovarian region, frequent urging 
to urinate, and itching in the genital organs.; painful coitus, little 
sexual desire, the discharge is of a varied nature, thick, creamy 
or yellowish, bland or excoriating, offensive, worse during the 
day and after coitus. 

Silic, acrid, excoriating discharge; or milky, in paroxysms, 
with cutting in the umbilical region; frequently, also, discharge 
during micturition. 

Sulphur, discharges of all sorts, mild and excoriating; in most 
chronic cases, just as in all other chronic catarrhal affections; 
burning of the soles of the feet, and heat in the crown of the 
head; too much animal heat; feeling of faintness, with strong 
craving for nourishment, about eleven o'clock every forenoon; 
A'ulva sore, burning and smarting. 

Parenchymatous Metritis. 

In its acute form it is of rare occurrence, and consists of an 
inflammatory process of the entire substance of the womb, in- 
cluding often both the mucous lining inside and the peritoneal 
covering outside. The uterine substance is tumefied, infiltrated 
with serum and hyperaemic. 

Its most frequent causes are irritating applications, injections 
of too hot or too cold water in the vagina, or intra-uterine injec- 
tions, pessaries, the introduction of the sound, etc. ; also, " catching 
cold," especially during the menses, etc. 

Commencing with a chill which is followed by fever-heat, it is 
characterized by a deep-seated pain in the region of the uterus 
and an acute pain in the peritoneal covering, greatly increased 
by pressure, or movements, such as turning, walking, standing, 
coughing or straining at stool. Manual examinations are scarcely 
endurable. If it commences during the menstrual period, it 
causes suppression of the flow, or at times flooding. It is often 
associated with ischuria, diarrhoea and tenesmus, nausea and in 
rare cases with vomiting. Uncomplicated cases may pass over 



752 UTERUS. 

in the course of several days; a termination in an abscess is of 
rare occurrence. 

The chronic form of parenchymatous metritis is also known 
under the name of infarction of the womb, and consists of a 
hyperplasia of the connective tissue of the uterus, out of its muscular 
tissue; it is accompanied by a variable degree of sensitiveness. 
The womb is always enlarged ; its substance succulent and red- 
dish, tumefied and hypersemic: the os is generally broad, and 
the lips are swollen and elongated, often ulcerated. 

Its Causes are of a widely different nature. Only rarely it de- 
velops out of the acute form, and then only when the organ by some 
cause or the other has been prevented from undergoing a com- 
plete restitution into its normal state. By far the most frequent 
origin lies in a defective retrograde evolution of the puerperal 
uterus in consequence of too early leaving the bed and assuming 
house-work again; or in consequence of retained secundines, or 
too early sexual intercourse, etc. This applies also to miscarriage 
and criminal abortion. 

Another variety of causes must be looked for in all those irri- 
tations which produce active hyperemia of the uterus, such as 
excesses in venere, fraudulent cohabitation and masturbation; 
also cauterization of the os by nitrate of silver or other means; 
and in all those conditions which produce a venous stasis in the 
organ, such as retroflexion and prolapsus, adjacent tumors, re- 
tention of urine in the bladder, etc. 

Its Symptoms are not in all cases very characteristically devel- 
oped; but as a rule we meet with frequent repetitions of acute 
and subacute exacerbations of at least some of the following 
symptoms: pain in the sacral region, in the abdomen, a sense of 
weight and bearing down in the pelvis, leucorrhcea, menorrhagia, 
constipation and frequent urging to urinate: pain during stool, 
or coitus. During the menstrual period all the symptoms are 
aggravated. Gradually digestion and appetite begin to fail, and 
a whole train of hysterical symptoms develop, such as various 
kinds of pain in the lumbar region and lower extremities, vagino- 
dynia, coccygodynia, paralysis of different organs, etc. 

It may bring on sterility, but not necessarily; is often compli- 
cated with endometritis, ovaritis, perimetritis and displacements, 
and terminates after the age of fifty at times in cicatricial indu- 
ration of the womb. By means of the conjoined examination 
the uterus is found to be enlarged and its sensitiveness increased. 



PARENCHYMATOUS METRITIS. 753 

especially during the periods of aggravations. The sound re- 
veals an elongation of the uterine cavity. 

The disease is very tedious, but not dangerous to life. If the 
uterus cannot be entirely restored to its normal state, the suffer- 
ings at least can be greatly relieved by homoeopathic treatment. 

THERAPEUTIC HINTS.— Compare Uterine Catarrh, Peritonitis 
and Displacements. 

Aeon., high fever ; dry skin ; intense thirst ; great restlessness ; 
fear of death, and predicting the hour of death. 

Arnica, when induced by external violence. 

Arsen., burning pain ; indescribable anguish and restlessness ; 
sudden sinking of strength ; burning thirst, drinks often, but lit- 
tle at a time; cold drinks make her worse; burning in the veins ; 
aggravation about midnight. 

Bellad., violent pains by spells ; clutching pains, as if something 
with nails were clawing the intestines together; meteorism, with 
eructations ; great sensitiveness and heat in the abdomen ; pain- 
ful bearing down in the pelvis towards the genitals and the rec- 
tum, with constant, ineffectual desire for stool ; suppression of the 
lochial or menstrual discharge, or else vitiated, fetid discharge. 
Congestion of the head, with delirium, redness of face, and throb- 
bing of the carotid arteries ; drowsy dozing with startings, or 
drowsiness, with inability to go to sleep. 

Bryon., wants to lie perfectly still ; the slightest motion causes 
pain ; in the head splitting pain ; in the bowels, limbs and -body 
stitch-like pain ; great dryness in the mouth, without thirst, or 
else great thirst, drinking tumbler after tumbler; perspiration in 
short spells, and only on single parts of the body; constipation. 

Calc. carb., fat persons, and those whose menses are too profuse 
and return too soon ; they sweat easily about the head, and are 
troubled constantly with cold and damp feet. Chronic infarction 
of the womb. 

Canthar., constant painful urging and tenesmus in the bladder ; 
likewise, in worst cases, when the patient lies unconscious with 
her arms stretched out along the side of her body, interrupted by 
sudden starting up, screaming, throwing about the arms and 
even convulsions ; all signs of erosions and ulceration of internal 
organs. 

Cauloph., insomnia; paraplegia; atony and relaxed condition 
48 



754 UTERUS. 

of the uterus ; hysterical spasms ; irregular menstruation ; exces- 
sive uterine haemorrhage. (M. M. Eaton.) 

diamoni., great agitation of the nervous system ; she seems be- 
side herself, with red face and heat all over ; she is ill-humored, 
and can scarcely restrain herself to treat people with civility ; 
sometimes one cheek red and the pther pale; after fits of passion. 

Coloc, colicky pains in the bowels, with deadly color of the 
face and bending double ; worse after eating or drinking ; par- 
tial heat, and partial coolness of the skin, with quick pulse, vom- 
iting and diarrhoea; bitter taste in the mouth; after indignation. 

Conium, swelling of the breasts ; stitches in the breast, mostly at 
night; induration of the cervix, with sharp pains in the part; 
acrid leucorrhcea; prolapsus uteri. (M. M. Eaton.) 

Crocus, black stringy discharge ; rolling and bounding in the 
abdomen, as from a foetus; stitching in abdomen arresting re- 
spiration. 

Gelsem., hystery ; hypersesthesia of a part of the body; tendency 
to hemiplegia ; confusion of mind ; sleeplessness ; spasms : fever, 
without thirst, intermitting; nervous exhaustion. (M. M. Eaton.) 

Hyosc, typhoid state ; either complete apathy, or else great ex- 
citability, spasms, jerkings, delirium, wild staring, throwing off 
bed clothes, making herself naked ; bright red clots after child- 
birth. 

Kreosot, putrid state of the womb after child-birth ; confound- 
ing ideas; loss of memory: thinks herself well; discharge of 
dark, offensive blood from the womb. 

Laches., constantly lifting the bed-clothes from the abdomen, 
on account of uneasy feeling caused by it; the j)ain in the uterus 
is relieved by a flow of blood for the time being, but returns soon 
afterwards: in bad cases, unconsciousness, livid face, repeated 
shaking chills; skin alternately burning hot and cold; abdomen 
distended; lochial discharge thin, ichorous; stool and urine 
suppressed. 

Mercur., inflammation of the genital organs and ulcers: moist, 
soft tongue, showing the imprints of the teeth, accompanied 
occasionally with great thirst; profuse sweat without relief: all 
worse at night. 

Nux vom., after taking cold, or using various kinds of drugs; 
in chronic cases, with bearing down into the vagina and towards 
the os sacrum ; constant urging to urinate ; constipation. 

Phosphor., fair, graceful women; after frequent pregnancies: 
pyseniic state and inflammation of the veins. 



PARENCHYMATOUS METRITIS. fOO 

Pulsat, after getting the feet wet; frequent chilliness; thirst- 
lessness ; deficiency of milk ; suppression of the lochial discharge ; 
mild, tearful disposition. 

Rhus tox., constant restless moving ; can't lie still ; dry tongue, 
with red tip ; red rash on the breast ; powerlessness of the lower 
limbs ; the lochial discharge turns bloody again ; typhoid symp- 
toms. 

Sabina, in metritis hemorrhagica. 

Secale, putrescence of the uterus ; abdomen distended, not very 
painful ; discharge from the vagina, brownish, offensive ; ulcers 
on the external genitals discolored and rapidly spreading; burn- 
ing hot fever, interrupted by shaking chills ; small, sometimes 
intermittent pulse ; great anguish, pain in the pit of the stomach, 
vomiting decomposed matter; offensive diarrhoea; suppressed 
secretion of urine ; the skin is covered with petechial and miliary 
eruptions, or shows discolored, inflamed places, with a tendency 
to mortification; the patient lies either in quiet delirium, or 
grows wild with great anxiety and a constant desire to get out of 
bed. 

Sepia, painful stiffness in the uterine region ; bearing down ; 
sense of weight in anus ; sense of goneness in abdomen ; yellow- 
ish spots in face. 

Sulphur, frequent weak, fainty spells, especially before noon ; 
bearing down, especially on standing; leucorrhoea; soreness of 
genitals. 

Ver. alb., if commencing with violent fits of vomiting and 
diarrhoea; hot body; cold extremities and deadly pale face, 
covered with cold perspiration ; delirium and great anxiety : 
suppressed lochial discharge ; nymphomania. 

Ver. vir., congestion of pelvic organs, tenderness of uterus ; 
fever; heat; restlessness; palpitation of heart; local or general 
hyperesthesia. (M. M. Eaton.) 

For the chronic form, Eaton recommends : Ars. jod., Merc, jod., 
Phytol., Ferrum, Merc, cor., Kali hydr., Xux vom., Ars. alb., 
Secale, Ignat., Iris vers., Hyosc, Ver. vir. 

Hydrometra, Haemometra, Partial or Total Closure of the 
Womb. 

In consequence of the just considered inflammatory processes, 
it happens now and then that exuberant granulations of the 



756 UTERUS. 

mucous lining or cicatrization of ulcers form adhesions within 
the neck of the uterus and thus cause a partial or total closure 
of its mouth. The same result may be produced by pseudo-for- 
mations within the womb, or certain flexions of the cervix uteri. 
In such cases it is obvious that any secretion within this organ 
either can not escape at all, or only with great difficulty, and 
under certain favorable circumstances. The secretion collects 
and distends the uterus sometimes to a very considerable size. 
This distention causes the mucous lining to grow thin, and its 
glandular structure, which naturally secretes mucus, to disappear; 
it now approaches the nature of a serous membrane, and secretes 
a serous fluid instead of mucus. Thus originates Hydrometra, or 
dropsy of the womb. 

Hsemometra it is called, when Hood, instead of serum, collects 
in the womb, in consequence of a . partial or total closure of its 
mouth. This takes place in women who still menstruate; or the 
occlusion is a congenital imperforation of the organ. In the first 
instance it is always attended with contractions of the womb, 
labor-like pains, or uterine colic at the period of menstruation, 
which may succeed in cases of a partial closure, to press the col- 
lected fluid out in gusbes ; in the latter case the menstrual dis- 
charge does not take place at all. The existing trouble may be 
suspected when repeated menstrual periods pass by without any 
flow, although the patient feels all the symptoms of it: periodical 
colicky contractions ; bearing-down sensation ; and all the rest 
of the symptoms of amenorrhoea and dysmenorrhcea. The abdo- 
men commences to enlarge above the os pubis. Only by a phy- 
sical examination can we discover the occult complaint, 

THERAPEUTIC HINTS.— It is clear that, if homoeopathic treat- 
ment of those inflammatory processes could not prevent adhe- 
sions and closure, medicines will not be likely to unclose them. 
Such cases require surgical treatment. 

Displacements of the Womb. 

The womb is by no means fixed immovably within the pelvic 
cavity; its fundus has almost entire freedom of motion antero- 
posteriorly; the round ligaments having their insertion in soft 
parts, allow very considerable excursions backwards. The cer- 
vix is more firmly connected, but only to the unstable bladder 



DISPLACEMENTS OF THE WOMB. 757 

in front and to the rectum behind. The vagina too gives no 
firm support, but follows the movements of the cervix. Only 
considerable lateral motion is prevented by the lateral ligaments. 
It is, therefore, not very strange, that displacements of this organ 
should frequently occur. Even within the boundaries of physio- 
logical correctness its position is greatly influenced by the vary- 
ing contents of the bladder and rectum. A full bladder presses 
it back, an empty bladder allows it to fall forward, and so also 
has the fall or empty rectum, though in less degree, a certain in- 
fluence upon its position. 

Anteversion and Anteflexion. 

In anteversion the entire organ inclines forward, has, so to say, 
fallen upon the bladder which it compresses, while neck and 
mouth point straight backward. There is but slight bending be- 
tween neck and body, or none at all. This form is always com- 
plicated with metritis, and when it exists in any considerable de- 
gree, it is accompanied by pain in the abdomen, haemorrhages, 
leucorrhcea, urinary difficulties, neurosis of the rectum and hys- 
teria.' It is easily detected by digital per-vaginam and conjoined 
examination. 

In anteflexion the body and cervix form an angle, the body 
having fallen down and forward upon the bladder, while the cer- 
vix retains its position in the vagina, or is slightly pointing back- 
wards. This form is usually attended with dysmenorrhcea, in con- 
sequence of the obstruction to the menstrual flow at the point of 
flexion. The pain begins before the appearance of the menstrual 
discharge, which has to be driven out by strong contractions of 
the womb, causing violent colicky pains, ending usually with a 
copious flow. There is also difficulty of conception, the semen 
being prevented from entering the womb at the point of flexion, 
and frequent desire to pass water on account of the pressure of 
the womb upon the bladder. It maybe complicated with metri- 
tis, perimetritis and endometritis. Here too digital and conjoined 
examination will reveal the nature of the disorder. 

Retroversion and Retroflexion. 

In retroversion the uterus dips backward towards the rectum 
and its neck and mouth point forward toward the symphisis, and 
in its most exaggerated form the uterus may be completel} 7 turned 



758 UTERUS. 

over, the os looking directly upward. Slight degrees of this form 
may be free of symptoms ; inveterate cases may be complicated 
with chronic inflammation. 

In retroflexion the body and cervix form an angle, the body 
having fallen backward toward the rectum, while the cervix re- 
tains its position in the vagina, or is slightly pointing forward 
towards the symphisis. This form is more apt to be attended by 
haemorrhages than by dysmenorrhoea, and occurs as a general 
thing most frequently in women who have borne children ; it is 
further characterized by a pain in the lover port of the spine; by 
paralytic or neuralgic symptoms of the lower extremities or else- 
where, in consequence either of direct pressure upon the motor 
nerves, or in consequence of reflex action ; by great irritation of 
the nervous system, showing itself as emotional, moral, or intel- 
lectual disturbances ; by urinary' troubles, and disturbances in 
the function of the rectum. 

The Diagnosis of retroversion and retroflexion can usually be 
made out by digital examination per vaginam et rectum and by 
the conjoined method ; only rarely it will be necessary to intro- 
duce the sound, which by no means is so free of danger as. seems 
to be supposed by many. 

Prolapsus and Procidentia. 

In prolapsus the uterus slips downward into the vagina, ap- 
proaching gradually with its os, the mouth of the vagina. The 
uterus standing in its normal position, about four inches above 
the vaginal entrance, its descent is one of degrees before it reaches 
the mouth of the vagina, and as it is fastened to adjoining parts 
it drags along in its course downward the bladder, the ovaries, 
the Fallopian tubes, the small intestines, the walls of the vagina 
and in some instances the rectum and portion of the colon. 

I am entirely of the same opinion as is expressed by Dr. Guern- 
sey in his work on obstetrics that " the peritoneum is the true 
uterine supporter," and " that the uterus can sink in the pelvis 
only so far as it is permitted by the relaxation of the peritoneum, 
its grand suspensory ligament." Recent authors come nearer and 
nearer to this same view. So says Sehroeder: "the predisposing 
cause will almost invariably be found to consist in a relaxation 
of all the pelvic viscera," and M. M. Eaton: "the uterus is sus- 
tained mainly by the folds of the peritoneum constituting the 






DISPLACEMENTS OF THE WOMB. 759 

broad ligaments, the cellular tissue surrounding it and the vagina, 
and by atmospheric pressure coming in through the vagina." 

The predisposing relaxation of the peritoneum being present, 
usually in consequence of some general weakness of the system or 
a sudden fright, any pressure from above, such as tight lacing, 
straining or heavy lifting, long-continued standing, the puerperal 
condition, etc., or insufficient support from below, such as lacera- 
tions of the perineum, will no doubt facilitate the descent of the 
womb. 

Symptoms. — In those rare cases where from a violent cause a 
sudden descent takes place, we have severe abdominal pain, 
fainting and profound nervous shock. The gradual descent cau- 
ses: bearing and dragging-down pain in the pelvis with pain in 
the small of the back, which is worse on standing, walking, lifting 
or doing any kind of bodily work, and better on lying down and 
resting; frequent desire to urinate and often inability to do it on 
account of the bladder being dislocated also; difficulties in defe- 
cation and a number of nervous symptoms known under the 
name of hysteria. Digital examination reveals the organ more 
or less far down in the vagina, resting in some cases upon the 
perineum. 

In procidentia, which is a complete prolapse, the uterus escapes 
through the vagina and lies either in part or wholly outside of 
the external genitals between the thighs. The vagina having 
become inverted, covers the protruded organ, and drags down in 
its cavity the bladder and rectum, in consequence of which a 
retention of urine in the drawn down portion of the bladder 
(diverticulum) and difficult defecation are necessarily produced. 

The Diagnosis of this trouble can hardly fail to be correct 
if an examination by inspection and palpation is properly 
conducted. 



Inversion of the Womb. 

By this we understand a turning of the uterus inside out. It 
can only take place when the organ is greatly enlarged, for in- 
stance, during parturition when the foetus is suddenly expelled, 
or afterwards upon undue pulling at the cord to deliver the pla- 
centa, or in cases of tumors, polypi, etc., at its fundus, which have 
softened the fundus and by their weight draw it down within the 
uterine cavity, dragging, by degrees, the uterine walls after, until 



760 UTERUS. 

at last a complete eversion is established. This process is often 
accelerated by uterine contractions to expel the foreign body. In 
the normal, unimpregnated uterus inversion never takes place. 

The degrees of inversion are as varied as those of prolapse, 
from a mere depression of the fundus into the uterine cavity, to 
a complete turning inside out and protrusion of the entire organ 
outside of the vulva. 

Its Symptoms are usually grave haemorrhages, shock and uri- 
nary difficulties, but in some cases it is borne without any re- 
markable disturbance of the system. 

THERAPEUTIC HINTS.— Many cases of these various kinds of 
displacements require, like hernia and other dislocations, taxis to 
reinstate the organ into its natural position ; others yield easily 
to well-chosen remedies. If taxis is necessary, it ought to be ex- 
ecuted with the utmost care and gentleness, and, if possible, by 
the hand alone. It is not necessary, nor even likely, in many 
cases, that we should succeed in one effort at restoration ; it took 
time for displacement; allow time also for replacement. With 
several gentle efforts, persistently followed up at reasonable pe- 
riods, much more may be gained, than by one grand attack with 
ether and chloroform, and all kinds of instruments. He is the 
greatest artist who accomplishes most by the simplest means. In 
anteversion or anteflexion, place the patient on her back, and ele- 
vate the pelvis ; steady with one or two fingers of the left hand, 
introduced into the vagina, the cervix, and with the right hand 
try to get under the fundus above the pubis through the relaxed 
abdominal walls, and force it gently upward and backward. In 
retroversion or retroflexion, place the patient on her left side or in 
the knee-chest position, raise the uterus gently by the introduced 
fingers of the right hand, and exercise at the same time upon the 
neck, which points towards the pubis, a steady pressure in a back- 
ward direction. The other hand may help either per rectum or 
through the abdominal walls in forcing the fundus forward. In 
prolapsus and procidentia, place the patient on her side or back, 
with the pelvis elevated, and push the organ gently upwards and 
in the direction of the natural curve of the pelvis, lest it might 
result in an artificial retroflexion by being forced against the 
sacrum. In inversion, the fundus of the womb must be pressed 
back again through the os, and the entire organ replaced — a 
work sometimes very difficult to accomplish, especially in chronic 
cases, when it properly belongs in the domain of surgery. 



DISPLACEMENTS OF THE WOMB. 761 

Some chronic cases of displacement are irreducible in conse- 
quence of adhesions with neighboring organs. In all cases of 
displacement, one of the first requirements for success is the re- 
moval of all pressure upon the womb from above, as is exercised 
by corsets, tight lacing, etc. ; supports from below by pessaries 
and supporters of all kinds have seldom proved themselves of 
great use, and often decidedly injurious ; rest, in a suitable posi- 
tion, with hips elevated, and continued for some time after re- 
placement, is often all that is needed. 

To secure the staying in place of the womb,, we must so select 
a remedy that it fits the peculiarities of the individual case ; it 
will certainly restore the necessary tonicity of the peritoneum. 

As regards SPECIAL HINTS, Drs. Guernsey and Eggert have 
made valuable contributions. Compare them if the following 
do not suffice. 

Aeon., after a sudden fright; also when inflammatory symp- 
toms prevail. Agonizing pain during the menses, with tossing 
about. Fear of death. 

Agar, muse, prolapsus after cessation of menses; bearing-down 
pain, almost intolerable. 

Amm. mur., pain as from a sprain in the groin, obliging one 
to walk crooked ; menses appear too soon, with pain in the 
belly and small of the back ; they flow more abundantly in the 
night; discharge of a quantity of blood with the stool during 
the catamenia. 

Argent, pain in the small of the back, which extends towards 
the front and downwards ; pain in left ovavj and loins. 

Arg. nitr., prolapsus, with ulceration of os or cervix uteri ; pain- 
ful coition, with bleeding from vagina. 

Arnica, after a bruise or concussion, which leaves a bruised and 
sore feeling in the lower part of the abdomen, so that she cannot 
walk erect. 

Aurum, after lifting a heavy load, a sense of weight in the 
pelvis, with ischuria and constipation, worse at each menstrual 
period; great dejection of spirits; longing for death, increasing 
to a desire for self-destruction ; or vehement, the least contradic- 
tion excites her wrath. 

BeEad., pressing early in the morning, as if all the contents of 
the abdomen would issue through the genital organs ; drawing 
pain in the small of the back downwards ; flow of blood between 
the periods ; great dryness of the vagina ; frequent, unsuccessful 



762 UTERUS. 

desire to urinate or to evacuate the bowels ; only a few drops of 
urine are discharged from the bladder, and some mucus from 
the rectum ; the uterus comes down when straining at stool ; or 
while urinating, and rises again on walking about ; back aches 
as if it would break ; dizziness ; roaring in the ears ; congestion 
to the head. 

Calc. carb., pressing on the uterus ; aching of the vagina ; sting- 
ing in the os uteri ; the menses appear too soon, and are too 
profuse ; milk-like leucorrhoea ; inclination to perspire easily 
about the head ; great liability to strain a part by lifting ; easily 
tired by bodily exertions ; in walking up stairs she feels dizzy 
and entirely exhausted ; even talking makes her weak ; great 
inclination to sigh ; she cannot get her breath long enough ; 
great susceptibility to catch cold ; the feet feel most of the time 
damp and cold, or else the soles' of the feet are burning hot ; 
great desire for hard-boiled eggs; big-belliedness ; scrofulous 
diathesis. 

Calc. phos., every cold causes pains in the joints, and in other 
places where the bones unite and form a symphysis or suture. 

Caidoph., retroversion ; menstrual colic; congestion and irrita- 
bility of uterus ; leucorrhoea profuse, mucous. 

Chamom., abortus ; colicky pain and bearing down, with fre- 
quent desire to urinate; frequent discharge of coagulated blood, 
with tearing pains in the veins of the legs, and violent labor- 
pains in the uterus ; she is inclined to be quarrelsome and angry ; 
can hardly stop talking about old vexatious things. 

China, general weakness in consequence of loss of vital fluids, 
either by haemorrhages, profuse diarrhoea, or debilitating illness; 
great disposition to sweat during motion and sleep ; feels worse 
from exposure to the slightest current of air ; all pains are worse 
from slightest touch. 

Conium, pain in the mammae before the menses ; pressure from 
above downwards, and drawing in the legs during the menses ; 
feeble or suppressed menses; sterility; smarting, excoriating 
leucorrhoea; the flow of urine suddenly stops; cough during 
pregnancy ; cough worse at night, and when lying down : vertigo, 
worse when lying down, or loooking round, or going down stairs ; 
induration of the urine in the mammae or other glands. 

Ferrum jod., retroversion and consequent pressure upon the 
rectum, that she can neither stand nor walk ; constant tenesmus, 
with frequent white slimy stools ; scanty, deep-colored urine ; 
nervous and hysteric spasms ; scrofulous diathesis. 



DISPLACEMENTS OF THE WOMB. 763 

Hydrast, nosebleed before menses; backache and headache 
before and duiing menses; discharge like white of egg after 
menses for ten days with great sexual desire, although coition is 
painful; after these ten days follows acrid, corroding leucorrhcea 
with great irritableness and aversion to coition ; at times profuse 
discharge of hot water from the womb. Constant desire to pass 
water, with relief after passing it; constipation, dry, lumpy feces 
are followed by a matter like white of egg. After eating, regur- 
gitation of food by the mouthful without nausea, with nervous- 
ness, irritability and headache; epigastric region tender to touch 
and a feeling as of a tight band around the waist, worse at night 
than in the morning; cannot sleep until after midnight. Pro- 
lapsus uteri with indurated os. (C. W. Boyce.) 

Ignat., violent crampy pressing in the region of the uterus, re- 
sembling labor-pains, followed by a purulent, corrosive leucor- 
rhcea; the menses are scanty, black and of a putrid odor; she 
seeks to be alone, is brooding to herself, and full of grief; all her 
pains are aggravated by drinking coffee or smelling tobacco 
smoke; gone feeling in pit of stomach. 

Kali carb., pain in the small of the back, as though it were 
pressed in from both sides, with labor-like colic and leucorrhcea; 
also during the menses ; the pains in the bowels are apt to recur 
about three o'clock every morning;, bloated face in the morning, 
especially between the eyebrows and upper lids; great dryness 
and itchiness of the skin; great tendency to start when being 
slightly touched. 

Laches., just as patients with a Lachesis-sore throat cannot bear 
anything touching their neck, so do women afflicted with womb 
diseases constantly pull their dress from off the abdomen ; violent 
labor-like pressing from the loins downwards during the menses, 
which are scanty ; palpitation of the heart, with numbness in the 
left arm ; constant feeling of something in the throat which she 
cannot swallow down ; feeling of a ball rolling in the bladder or 
abdomen, or in both places; climacteric period. 

Lil. tigr., feels as though she would drop asunder, must press 
with hand against vulva; worse in standing and sometimes when 
recumbent: frequent ineffectual urging to urinate and defecate. 
Menses scanty, flowing only as long as she is moving about; 
leucorrhcea profuse and corroding; she feels always in a hurry, 
yet cannot accomplish anything. 

Lycop., chronic dryness of the vagina; pressing through the 



7G4 UTERUS. 

vagina on stooping; chronic suppression of the menses after 
fright; incarcerated flatulence; varicose veins on the lower ex- 
tremities; jerking and twitching of single limbs or of the whole 
body, sleeping or waking; always wakes up very cross. 

Mercur., peculiar weak feeling in the abdomen, as though she 
had to hold it up; close above the genital organs a sensation as 
if something heavy were pulling downward, accompanied by a 
pulling pain in both thighs, as if the muscles and tendons were 
too short. During the menses red tongue, with dark spots and 
burning; salt taste in the mouth; sickly color of the gums, and 
the teeth are set on edge; great tendency to perspire; all the 
symptoms worse at night; inexpressible feeling of some internal, 
insupportable illness. 

Natr. mur., pressing and pushing from the side of the abdomen 
towards the genital organs early in the morning; she has to sit 
down to prevent a prolapsus uteri; dryness of the vagina and 
painful embrace; burning and cutting in the urethra after mic- 
turition; headache on waking every morning; faint, weak voice, 
and exhaustion from talking; after abuse of quinine, or the local 
application of nitrate of silver. 

Nitr. ac, violent pressing in the hypogastrium, as if everything 
were coming out at the pudendum, with pain in the small of the 
back, through the hips and down the thighs ; she feels so weak 
that she loses breath and speech. Inclined to looseness of the 
bowels ; most violent, cutting pain after an evacuation, lasting 
for hours; she feels, on the whole, better, when riding in a 
carriage. 

Nux vom., prolapsus after straining by lifting, or after miscar- 
riage ; constant, painful pressing and burning in the uterine re- 
gion ; pressive pain in the small of the back, worse when turning 
in bed ; drawing in the thighs ; constant, unsuccessful urging to 
stool and constant desire to urinate; the patient wakes after mid- 
night and lies awake for hours, then falls into a heavy sleep 
again, constantly dreaming until late in the morning, when she 
feels disinclined to rise. Always the first remedy after allopathic 
drugging. 

Platina, great heaviness, pressing in the genitals, extending 
through the groins as far as the small of the back : profuse 
menses; great sensitiveness of the parts, with pressing from 
above down; internal chilliness and external coldness: consti- 
pation; feeling of numbness and rigidity here and there; also 



DISPLACEMENTS OF THE WOMB. 765 

with trembling and palpitation of the heart; haughty disposi- 
tion. 

Podoph., prolapse from overlifting or straining and often par- 
turition ; great costiveness ; frequent micturition ; weakness and 
soreness of back, especially after washing; prolapsus ani. 

Pulsat., chilliness and paleness of face ; bad taste in the morn- 
ing and dry tongue without thirst ; is easily moved to tears. 

Rhus tox., after a strain or hard labor ; she feels worse after any 
long walk ; the pain in the small of the back is relieved by lying 
on a hard couch. 

Secale. after parturition ; weakly, thin women. 

Sepia, pressing in the uterus, oppressing the breathing, from 
above downwards, as if everything would come out of the va- 
gina, accompanied with colic ; she had to cross her limbs to pre- 
vent it, followed by a discharge of jelly-like leucorrhcea; sense 
of weight in the rectum not relieved after stool, slow and difficult 
evacuation from the bowels, although the excrements are soft; 
pot-belliedness ; yellow saddle across the bridge of the nose; gone 
feeling in pit of stomach, great weakness, tiredness, despondency 
and disinclination to move. 

Sulphur, weak feeling in the genital organs and pressure on the 
parts ; troublesome itching of the pudendum, with pimples all 
around and burning in the vagina ; she was scarce^ able to sit 
still ; the menstrual blood is thick, black, and so acrid that it 
makes the thighs sore; burning and smarting leucorrhcea; sud- 
den, imperative urging to urinate to prevent an involuntary flow; 
weak, fainty, between 11 and 12 a.m., must have something to eat; 
restless and sleepless nights; or heavy sleep which exhausts her; 
heat on the top of the head with cold feet; always feels too hot, 
especially her feet, which compels her to put them from under 
the cover: walks stooping; all the symptoms worse while stand- 
ing ; psoric diathesis. 

Ver. alb., after great fear or fright, with cold sweat, exhausting 
vomiting and diarrhoea. 

Zincum, usually feels best during menses; fidgety of feet. 

Besides compare the chapter on Leucorrhcea. 

Morbid Growths within the Womb. 

Mucous polypi are usually an outgrowth of chronic catarrh, and 
consist of enlarged follicles, which elevate the loosely-textured 
mucoiis membrane, gradually forming club-shaped bodies which 



766 UTERUS. 

hang on a slender pedicle or stem from the fundus down towards 
the os, or if situated near the cervix, protrude through the exter- 
nal os. Their covering membrane being very vascular, gives 
them a cherry-red color, and they bleed easily and often pro- 
fusely ; their size varies from that of a pea to that of a hazel-nut, 
seldom much larger. 

Fibrous polypi consist of submucous fibroids, which project into 
the cavity of the uterus, and are covered by the mucous mem- 
brane which they push forward. They arise from the body of 
the womb, and remain more or less continuous with the same by 
means of a more narrow or broader pedicle. Their size varies 
greatty, and may attain to the dimensions of a child's head and 
over. Such growths should properly be called submucous fibroids, 
but are best known under the name of uterine fibrous polypi. If 
these morbid growths take in their development an outward di- 
rection towards the peritoneal covering, which they naturally 
push before them, they are called subserous fibroids, and if they 
develop within the uterine wall itself, constituting a portion of 
the same, they are called interstitial, intraparietal or intramural 
fibroids. 

It is often the case that all three kinds of fibroids are associated 
with each other. These tumors do not directly endanger life, 
but may become dangerous through haemorrhage or suppuration 
and ichorous degeneration, and constitute at best a constant in- 
terference with the enjoyment of life. 

THERAPEUTIC HINTS.— As the most important remedies com- 
pare Calc. carb., Calc. phosph., Conium. Lycop., Nitr. ac, Phos- 
phor., Sanguin., Silic, Staphis., Teucrium, Thuja. Many others 
may be indicated in individual cases. In case of haemorrhages 
compare the respective chapter. Operative means belong into 
the domain of surgery. 

Moles are fleshy bodies of various sizes, to which is attached a 
sac filled with fluid resembling the amniotic fluid : they are em- 
bryos not normally developed. The cause for this failure of nor- 
mal development may lie in the ovum, being from some cause or 
the other incapable of a normal development ab initio, or in the 
semen, being not healthy enough to insure a normal growth, or, 
according to Eaton, in the too small number of spermatozoa, 
which penetrate the ovum. This latter may be the result of 
using a syringe after connection, or of withdrawing the penis 



CANCER OF THE WOMB. 7G7 

before ejaculation, or of constriction of the cervical canal in con- 
sequence of flexion, preventing the free ingress of semen into the 
uterus. 

Its Symptoms are usually those of pregnancy; and when the 
abnormal mass is expelled by the efforts of nature, the indications 
for remedial aid correspond to those of abortus. 

Hydatids are numerous cysts or vesicles attached to each other 
like a bunch of grapes, filled with a transparent fluid like water. 
Upon microscopical examination they were found to contain the 
heads of echinococci, and as hydatid developments are not con- 
fined to the uterus, but have been found also in the liver, lungs, 
testicles and mammae, they cannot be considered as the result of 
imperfect impregnation. 

Cancer of the Womb. 

Carcinoma is, according to Waldeyer, "developed by normal 
pavement or glandular epithelium penetrating with its ramifica- 
tions into the depths of the tissues in all directions like plugs, 
destroying the other tissues in all directions by pressure and 
forcing apart the bundles of connective tissue-fibres, so as to form 
for itself a framework of connective tissue and an alveolar struc- 
ture for the whole tumor." 

"According to the preponderance of either this connective tis- 
sue framework, or the nests of cancerous epithelium, we distin- 
guish the harder forms as Scirrhus and the softer as Medullary 
cancer." 

The degeneration begins almost always at the vaginal portion, 
rarely extends to the fundus, is, however, very apt to spread down 
the vagina, over to the bladder and rectum, causing, at this period 
of its decay, a most horrid destruction of these parts. Its most 
important Symptoms are pains in the small of the back, loins and 
groins, which grow more and more violent; haemorrhages, at first 
only during the menstrual periods, later at anytime; and leu- 
corrhcea, which becomes more and more watery, corroding and 
offensive. 

The Cauliflower excrescence is a cancroid hypertrophy of the 
papillae in the mouth of the womb, which sometimes attains an 
enormous size in the shape of cauliflowers. It looks bright red, 
bleeds easily and is prone to cancerous degeneration, in which 
state it undermines the general constitution by pain and loss of 



768 UTERUS. 

blood, like cancer of the womb, to which it is similar in all its 
symptoms. A Differential Diagnosis between the two can be 
gained only by an examination with the speculum. 

THERAPEUTIC HINTS.— Arsen., great exhaustion; restlessness 
and fits of anguish, with terrible, sharp, burning pains ; all worse 
about midnight; acrid, corroding and burning discharges, watery, 
light or dark colored, often very offensive. 

Aur. mur., stinging, cutting, pressive pains in the uterine region; 
very offensive discharges; belching up of wind; craves nothing 
but sour things. 

Bellad., painful bearing down in the pelvis, as though every- 
thing would fall out of the genitals; a similar pain in the small 
of the back; frequent, transient stitches in the region of the womb; 
hgemorrhages from the womb, profuse, often very offensive. 

Calc. carb., burning soreness in the genital organs; aching in 
the vagina; profuse menstruation; flow of blood between the 
monthly periods; cold feeling on the top of the head; great 
sensitiveness to cold air and liability to catch cold ; scrofulous 
diathesis. 

Carb. an., burning in the abdomen, extending into the thighs ; 
labor-like pain in the pelvis and small of the back, extending 
into the thighs, with discharge of slimy, discolored blood; irregu- 
lar menses; uterus swollen and hard; cachectic appearance of 
the face ; earthy color of the skin ; great weakness. • 

Carb. veg., paroxysmal spells of burning in the uterine region; 
varicose veins on the external genital organs ; cold knees in bed. 

Conium, stitching pain in the womb, accompanied by such 
symptoms as accompany pregnancy : nausea and vomiting; crav- 
ing sour or salt things; pain and swelling of the mamma' during 
the menses; dejection of spirits, etc. 

Graphit., cauliflower excrescence; burning, stitching pains, like 
electric shocks, through the womb, extending into the thighs; 
great heaviness in the abdomen when standing, with increased 
pains and faintness; menses only every six weeks, with a dis- 
charge of black, clotted, offensive blood, and an increase of all 
the sufferings; constipation; earthy color of the face: frequent 
chilliness; sad, desponding. 

Iodium, cutting in the abdomen, with pains in the loins and 
small of the back; uterine haemorrhage at every stool: indura- 
tions of the uterus; painfulness and feeling of heaviness in both 



CANCER OF THE WOMB. 769 

mammae; they hang down, relaxed and lose their fat; dwindling 
and falling away of the mammae; the patient feels worse from 
external warmth; after abuse of mercury. 

Kreosot, cauliflower excrescence ; awful burning as of red-hot coal 
in the pelvis, with discharge of clots of blood having a foul smell ; 
bearing down and sense of weight in the pelvis ; drawing pains 
in the small of the back and uterine region, extending to the 
thighs, intermingled with stitching pains; the vagina is swollen 
and burning hot ; long-standing leucorrhcea, becoming more and 
more watery, acrid, bloody, and ichorous all the time ; frequent 
haemorrhages from the womb; dwindling and falling away of 
the mammas, with small, hard, painful lumps in them; wretched 
complexion ; great debility ; sleeplessness. 

Laches., pain in the parts as if swollen, they do not bear contact, 
and have to be relieved of all pressure; coughing or sneezing 
causes stitching pains in the affected parts ; tenacious and acrid 
menstrual flow with labor-like pains ; discharge of a few drops of 
blood from the nose before the menses, which are scanty and de- 
laying ; especially indicated during the climacteric period with 
frequent uterine haemorrhages. 

Lycop., drawing in the groin; burning and gnawing; chronic 
dryness of the vagina; pressing through the vagina on stooping; 
discharge of wind through the vagina ; pain in the small of the 
back, extending down to the feet ; incarcerated flatulence, with 
rumbling in the left hypochondriac region ; red, sandy sediment 
in the urine ; jerking of single limbs awake or asleep ; feels worse 
in general from four to eight o'clock p.m. 

Magn. nmr., scirrhous induration of the womb; uterine spasms 
extending to the thighs and occasioning leucorrhcea ; discharge 
of black clots of menstrual blood, more when sitting than when 
walking ; large, hard, difficult stools which crumble off as they 
are expelled. 

Merc, sol., syphilitic taint, prolapse of the vagina; swelling of 
inguinal glands. 

Murex purp., a lively, affectionate disposition has turned to mel- 
ancholy from the affects of the disease; frequent, profuse menstru- 
ation, and strong sexual desire ; soreness in the region of the cer- 
vix, or a feeling as though something was pressing on a sore spot 
in the pelvis, with pain in the right side of the uterus, going into 
the abdomen or thorax ; watery, greenish leucorrhcea, irritating 
the parts; dragging and relaxation in the perineum; pains in 
49 



770 UTERUS. 

the hips, loins, and down the thighs, worse from exertion. (B. 
F. Betts.) 

Nitr. ac, irregular menstruation in shorter or longer intervals ; 
during the intervals a profuse, discolored, brownish, and offensive 
leucorrhcea; great debility, nervousness, and depression of spirits; 
heemorrhoidal tendency; great pain in the rectum after stools, 
lasting for hours, even worse after a diarrhceic evacuation ; the 
urine is very offensive. During a ride in the carriage they feel 
much better. 

Natr. carb., induration of the neck of the womb ; the os uteri is 
out of shape ; pressing in the hypogastrium towards the genital 
organs, as if everything would come out ; metrorrhagia ; putrid 
leucorrhcea; headache in the sun and from mental labor; she 
gets nervous from playing on the piano, and feels great anxiety 
during a thunder-storm. 

Phosphor., frequent and profuse metrorrhagia, pouring out freely 
and then ceasing for a short time; heat in the back; chlorotic ap- 
pearance ; instead of menses, watery, slimy or acrid discharge, 
causing blisters. 

Phytol., menses too frequent and too copious ; mammas painful ; 
sterility ; constipation ; syphilitic taint. 

Rhus tox., great soreness in vagina preventing an embrace ; the 
menstrual flow, being profuse, protracted and of light color, causes 
biting pain in the vulva. 

Sepia, induratio colli uteri or vaginae; painful stiffness in the 
uterus; pressing from above downwards, oppressing the breath- 
ing; must cross her thighs, in order to get relief; pot-belliedness; 
yellow saddle across the bridge of the nose; feels worse while 
riding in a carriage. Menses scanty : aversion to coitus ; sad and 
indifferent. 

Silic., she feels nauseated during an embrace ; diarrhoea or else 
great costiveness before tbe menses; increased menses, with re- 
peated paroxysms of icy coldness over the whole body at the time 
of their appearance; indurations of the mamma?; most of the 
symptoms make their appearance about new moon. 

Tarant, cancerous ulcer of os, induration of neck and fundus, 
chronic vaginitis with granulations. (Xuilez.) 

Thuja, cauliflower excrescences. 

Besides compare : Apis, Calc. carb., China. Clemat, Coccul., 
Hydrast., Sabina, Staphis., Sulphur and others. 



HYSTERALGIA — METRORRHAGIA. 771 

Hysteralgia. 

Under this term we understand a neuralgia uteri, or as it was ' 
formerly called, an irritable uterus, which consists of severe, often- 
times even excruciating pains in the region of the womb, without 
our being able to prove the existence of corresponding changes in 
the uterus by our present methods of investigation. Hysteralgia 
therefore, excludes all those cases where the existing pain can be 
traced to morbid alterations objectively demonstrable. These 
attacks of neuralgic pains are prone to remissions and aggrava- 
tions, greatly influenced by the state of the atmosphere, by men- 
tal or emotional excitements, by indigestion, etc., and are gener- 
ally found in women of a nervous temperament. 

THERAPEUTIC HINTS.— Here, too, as in all neuralgias, the num- 
ber of remedies which may be indicated is very large. 

In pains running upward : Laches., Lycop., Phosphor., Sepia. 

Downward : Ipec, Nux vom., iEscul. 

From os ilii forward and downward : Bryon. 

From groins outward and backward : Sepia. 

From groins to back : Sulphur. 

From back to groins : Sabina. (J. C. Morgan.) 

Dreadful bearing-down, dragging-out feeling : Secale. (Burnett.) 

Compare the chapters on Abnormal Menstruation, especially 
Dysmenorrhea. 

Metrorrhagia, Haemorrhage from the Womb. 

We understand by metrorrhagia a more or less profuse flow of 
blood from the womb at any other time than that of the men- 
strual period. 

1. It may occur in the not pregnant state of the womb, in conse- 
quence of abnormal fluxion to that organ, or in consequence of 
morbid growths in the womb and disorganizations of the organ, 
as shown in the previous chapters, or (and that is, perhaps, its 
most frequent occurrence) in consequence of those conditions 
which lead to the so-called " change of life " in the female organ- 
ism ; here it is, perhaps, not always distinguishable from a mere 
profuse menstruation. 

2. It may occur during pregnancy. With some women it is 
almost a rule, that the menstrual period is repeated several times 



772 UTEKUS. 

after conception, without apparent injury to the child. In others, 
however, a haemorrhage during the first months of pregnancy is 
the forerunner of abortion. Haemorrhages during the second half 
of pregnancy are often signs of a placenta previa, or likewise 
forerunners of miscarriage. 

3. It may occur after the expulsion of the child, whether it be 
fullgrown or not. Such bleedings are generally of great import- 
ance. They are almost always (if not occasioned by mechanical 
injuries) the consequence of insufficient contractions of the womb, 
the causes of which consist either of protracted or exhausting 
labors, or a too rapid expulsion of the child, or a partially- 
adhering placenta, or large blood coagula within the womb. 

4. When occurring later, during the lying-in time, the haemor- 
rhages are usually not so profuse and happen chiefly in women 
who do not nurse the child. Sometimes, however, they may be 
caused by an inflammatory irritation of the womb. 

5. It may occur during an attack of typhus, variola, cholera, etc. 

Metrorrhagia sets in frequently with chilly spells. The bleed- 
ing is either in gushes, or a continuous flow of bright red or dark 
blood. The face turns pale, the extremities grow cold; there is 
anxiety, restlessness, labor-like pains or colic; sometimes diffi- 
culty in breathing; vomiting and even convulsions. A great 
loss of blood brings on the signs of anaemia : coldness and deadly 
paleness of the face ; chills ; cold perspiration ; darkness before 
the eyes ; ringing in the ears ; faintness, drowsiness, weak pulse, 
convulsions. 

THERAPEUTIC HINTS.— Apocyn. cann., the flow is either contin- 
uous or paroxysmal ; the blood fluid or clotted ; there is nausea, 
vomiting, palpitation of the heart, great prostration and fainting 
when raising the head from the pillow. 

Arsen., pale, hippocratic face ; sunken, lustreless eyes, and icy 
cold extremities, spots and blisters on skin, with oozing of blood. 

Arnica, after difficult labor or external injuries; head hot; re- 
maining body cool. 

Bellad., great bearing down, as if everything would be pressed 
out, or a pain from the sacrum through the pelvis to the pubis ; 
the blood feels hot ; headache ; loss of consciousness ; darkness 
before the eyes ; enlarged pupils ; cold nose ; oppression, groan- 
ing, yawning, jerkings of the arms ; convulsive clenching of the 
thumbs. 



METRORRHAGIA. 773 

Calc. carb., climacteric period; chronic; mixed with leucor- 
rhoea ; previously always inclined to profuse and protracted 
menses. 

Cauloph., threatening abortion, and with spasmodic bearing- 
down pains; great vascular excitement; passive haemorrhage 
after abortus or confinement ; tremulous weakness of the whole 
system. 

China, at the commencement or actual presence of the above 
described symptoms of anaemia. 

Chamom., threatening abortus or actual abortion; labor-like 
pains from the small of the back extending to the genitals; blood 
dark and clotted. 

Crocus, dark, viscid, stringy blood, in black clots ; feeling as if 
something alive were in the abdomen; nervous excitement; pal- 
pitation of the heart ; fearfulness ; after being overheated, strain- 
ing and lifting ; after abortus and delivery ; worse from slightest 
motion ; yellowish, earthy color of the face. 

Eriger., uterine haemorrhage, with violent irritation of the 
rectum and bladder ; after abortion, with diarrhoea and dysuria. 

Ferrum, partly fluid and partly black, clotted blood ; labor-like 
and colicky pains; fiery red face; frequent short shudderings; 
headache and dizziness ; constipation and hot urine. 

Hamam., passive haemorrhage, with anaemia; soreness of the 
abdomen. 

Hyosc, continuous flow of bright red blood, or in bright red 
clots, with spasmodic jerkings of the body and great vascular 
excitement; nausea; vomiting; hiccoughing. 

Ignat, after the abuse of chamomile tea; after mental excite- 
ment and depression; gone feeling in pit of stomach. 

Ipec, especially after child-birth or the taking away of the pla- 
centa ; the flow is continuous, and the patient gasps for breath and 
is deadly pale. 

Kreosot, black blood in large quantities and of an offensive 
smell ; during the climacteric period. 

Kali carb., threatening abortus and consequences of it; great 
weakness in the small of the back and lower extremities; pain in 
the small of the back as though it were broken; dry, hacking 
cough; obstinate sweating, with feverish chilliness; chronic in- 
flammatory states of the womb, with nausea and vomiting. 

Laches., climacteric period. 

Lycop., partly black, clotted, partly bright red blood, and partly 



774 UTERUS. 

bloody serum, with labor-like pain, followed by swooning; dis- 
tention of the abdomen in different places, changing localities; 
pain in the small of the back, extending into the thighs ; worse 
in the afternoon from four o'clock, commencing with chilliness ; 
restless sleep; dreams of falling down from a height; especially 
for women who habitually menstruate profusely. 

Mercur., frequent fainting; profuse, cold perspiration on the face; 
collection of slime in mouth and throat; external swelling of the 
genitals. 

Nitr. ac, after miscarriage or confinement; diarrhoea, with cut- 
ting pain in the rectum after stool ; urine of an intolerably strong 
smell. 

Nux vom., during the climacteric period, and especially if such 
persons have been drugged previously by allopathic nostrums, or 
have used much coffee or alcoholic drinks, or too highly-seasoned 
food ; if they lead a sedentary life, complain much of costiveness 
and headache, suffer with piles, etc. 

Phosphor., between the menses and during pregnancy; lame 
and bruised feeling in the small of the back; dry cough and 
tightness in the chest, worse before midnight; great heat on the 
top of the head or in the spine; a great deal of vertigo; chronic 
looseness of the bowels, worse in the morning, or else chronic con- 
stipation, with dry, narrow stools. 

Platina, during pregnancy ; after confinement ; after great men- 
tal emotions; dark, thick, not coagulated blood; pressing pain 
from the small of the back downward upon the pelvic organs, as 
though they would come out, with great sensitiveness of the 
external organs, and nymphomania; sometimes a feeling as if 
limbs and body were growing larger. 

Plumbum, during the climacteric period; dark clots, alternating 
with fluid blood or bloody serum, with a sensation of fulness in 
the pelvis and slight bearing-down pains from the small of the 
back to the front; skin dry, pale, yellowish; here and there 
"liver-spots"; great debility, short breath on going up stairs: 
depressed spirits. Poisoning with lead brings on abortus. 

Pulsat, dark, coagulated blood emitted in paroxysms: worse in 
the evening, with labor-like pains; habitual looseness of the 
bowels; ordinarily rather scanty menses; yielding disposition. 

Rhus tox., bright red blood; threatening abortus, induced by 
straining or lifting; trembling sensation in the middle of the 
chest; contractive pain around the hypochondria; drawing, tear- 



METRORRHAGIA. i , 

ing in the back, loins and hips; cramp-like contraction of the 
thighs; aching all over, worse during rest; heavy, unrefreshing 
sleep, full of dreams. 

Sabina, blood bright red or dark, also in clots, sometimes alter- 
nating, now dark, coagulated, and then, again, thin and bright 
red; flows mostly in paroxysms, which are brought on by the 
slightest motion; or it ceases when walking about; drawing, 
cutting, pressing pains from the small of the back to the genitals 
and into the thighs; women who menstruate early and almost 
always profusely; gout.y diathesis; when the patient feels better 
in cool and worse in warm temperatures ; threatening abortus ; 
after miscarriage and confinement. 

Secale, atonic haemorrhages during the critical age; after con- 
finement; dark, seldom coagulating blood, sometimes fetid; no 
pain, or only slight bearing down; flooding, worse from the 
slightest motion; trembling, convulsive jerkings of the limbs: 
cramps in the calves of the legs ; general coldness. 

Sepia, climacteric age, or during pregnancy, especially during 
the fifth and seventh months; congestion of the head; fulness 
and pressure in the chest; spasmodic contractions in the abdo- 
men, with terrible bearing down; induration of the womb: vari- 
cose veins; yellow, sallow complexion. Such patients are very 
irritable, and faint from any little exertion. 

Sulphur, in chronic cases, when other remedies do not prevent 
its return; psoric taint of the system; eruptions here and there, 
or previously suppressed eruptions; looseness of the bowels early 
in the morning, or else great constipation; fits of gnawing hunger 
before dinner; the patient complains of great heat, or flushes of 
heat; has sleepless nights, seemingly without cause, or on ac- 
count of a tormenting itching all over the body; itching about 
the anus and genitals; chronic leucorrhcea, etc. 

Trillium, gushing of bright red blood at least movement, at 
times dark clots; frequent desire to urinate. Sallow face with 
Avhite lips and tongue; tossing in bed from evening until after 
midnight, with a feeling as if hips and small of back were falling 
to pieces and a desire to bind them up tightly. (F. G. Gilchrist.) 

Ustilago, at the climacteric period; active and constant flowing 
with frequent clots. 



< , b MENSTRUAL ANOMALIES. 

MENSTRUAL ANOMALIES. 
1. Menorrhagia 

Is. like metrorrhagia, a profuse flow of blood from the womb; 
only with the difference that it occurs at the time of the menstrual 
period. This period may keep regular time, or it may come too 
soon, or it may last too long; in some cases the menses are too 
profuse, too early and lasting too long. Its causes are various. 
"We may trace it to different structural changes and morbid 
growths of the uterus: to stagnation of the blood in the uterine 
veins, depending upon heart and lung diseases: to fluxions to 
the womb, brought on by sexual excesses, or sexual excitements 
by loose literature or onanism: to hemorrhagic diathesis, as in 
scurvy, purpura hemorrhagica, hemorrhagic small-pox, mea- 
sles, typhus, etc. Such cases, however, are of rare occurrence. 
The blood is either fluid or coagulated, and may differ greatly in 
color and character. Strong, plethoric women may endure men- 
orrhagia for a long time: weak, feeble women soon show signs of 
anemia. 

THERAPEUTIC HINTS. — Compare the preceding chapter on 
Metrorrhagia, and likewise those which treat of its causes as 
stated above. 

Amm. carb.. premature and very copious flow, especially at 
night, when sitting or riding, and after a ride in the cold air; 
with spasmodic pains in the belly and hard stools, with tenes- 
mus ; cholera-like symptoms at the commencement of the flow. 

Arg. nitr.. congestion of the uterus: cutting pains in the small 
of the back and groins : cramp in the stomach : great debility of 
the lower limbs ; vertigo and enlarged feeling of the head. 

Bryon.. menses premature and too profuse; dark red blood; 
tearing in the limbs ; splitting headache from the least motion, 
even on moving the eyes: white-coated tongue; great thirst; 
bilious vomiting; tearing in the limbs: constipation: stools as if 
burnt : or diarrhea in the morning. 

Calc. carb.. profuse, too early and lasting too long; anemic 
symptoms and congestions of the head and chest: leucorrhoea 
afterwards; scrofulous diathes - 

Calc. pbospL. menses every two weeks, black and clotted : before 
their appearance, griping and rumbling in the bowels : leucor- 



MENORRHAGIA. j i i 

rhoea ; stitching pains in the left side of the head ; sleepiness 
daring the day. 

Cann. ind., violent uterine colic; great nervous agitation and 
sleeplessness ; or cold hands and feet. (W. C. Richardson.) 

Cnamom., profuse discharge of dark, almost black coagulated 
blood, with drawing, clawing pains from the small of the back to 
the os pubis; irritable; fainting spells ; cold extremities. 

Cimicif., profuse and too early ; dark, coagulated blood ; aching 
in the limbs ; severe pain in the back, down the thighs, and through 
the hips, with heavy pressing down; weeping mood; nervousness; 
hysteric spasms ; great pain in the head and eyeballs, increased by 
the slightest movement of the head and eyeballs. 

Coccnl., profuse and too often; when rising upon the feet, it 
gushes out in a stream ; paralytic feeling of the lower extremi- 
ties. 

Cocc. cacti flow only in evening after lying down, not when 
stirring about ; urging to urinate but cannot pass water until a 
clot of blood is discharged ; nausea, vomiting. (C. B. Knerr.) 

Collins., menorrhagia in connection with constipation and piles. 

Crocus, profuse, and lasting too long, but coming at the right 
time; dark, clotted, stringy blood; wretched, pale, yellowish 
color of the face ; palpitation of the heart on going up stairs ; 
great debility. 

Cyclam., "the flow almost ceased as long as she was moving 
about at work, but as soon as she sat down quietly in the even- 
ing the flow reappeared and continued after she went to bed." 
(H. Ring.) 

Digit, venous, passive congestion, with pale or livid color of 
the face ; coldness of the skin : swelling and painfulness of the 
feet ; all in consequence of some cardiac anomalies. 

Eriger., profuse and too frequent, with violent irritation of the 
rectum and bladder. 

Ferrnm, profuse, too frequent, and lasting too long; with a fiery- 
red face, whilst at other times the face is pale and earthy looking. 

Gelsem., almost continuous flow, without any pain. 

Hyosc, profuse, with delirium ; convulsive trembling of hands 
and feet ; silly manners, rage. 

Ignat, profuse, too frequent and lasting too long ; after great 
mental troubles, grief or fright ; empty feeling in the pit of the 
stomach ; great sensitiveness of mincl without complaining. 

Ipec., very profuse, with heavy breathing ; constant nausea. 



778 MENSTRUAL ANOMALIES. 

Iodium, profuse and too early ; ovarian region painful, or sensi- 
tive to pressure; emaciation, notwithstanding a good appetite; 
chronic catarrh of the lungs. 

Kreosot, profuse and last too long ; great distention of the abdo- 
men before the menses, so that she appears as though she were 
pregnant; blood offensive; leucorrhcea between the menstrual 
periods ; headache before menses ; is very stubborn and irritable. 
"Worse in lying, better from walking about." (Von Villers.) 

Lycop., profuse and lasting too long ; sadness and melancholy 
before the menses ; yellowish color of the face ; frequent jerkings 
of the limbs ; incarcerated flatulence. 

Nux vom., profuse and too early; great sensitiveness of the ner- 
vous system; can't bear light or noise; is put out of patience 
when spoken to ; gets angry and violent without any provocation : 
is headstrong and self-willed ; of gets frightened easily, and is 
almost beside herself from the least thing that may happen ; she 
shuns the fresh air. After coffee, liquors, high-seasoned food, 
drugs, sedentary life. 

Phosphor., profuse, too early and lasting too long ; or too late, 
but very copious ; afterwards great weakness, blue rings around 
the eyes ; losing of flesh and great fearfulness ; tender, sensitive 
women, with frequent heat in the back, and cold legs. 

Platina, profuse, too frequent and long lasting; dark blood: 
pressing-down pains ; excited sexual desire. 

Secale, profuse, dark, without pain, lasting too long, being aggra- 
vated by the slightest motion or mental emotion. 

Sepia, profuse, either too early or at the right time; venous con- 
gestion of the head ; one-sided headache, with nausea and vomit- 
ing; loathing of all food; pot-belliedness after confinement: 
constipation ; yellow spots on the face. 

Trillium, menses every fourteen days, lasting seven and eight 
days ; in the intervening time profuse leucorrhcea of a yellowish 
color and creamy consistence. The blood is at first bright red, 
but owing to anaemia, grows pale. 

Veratr., profuse and too early; commencing with vomiting and 
diarrhoea; sensation upon the top of the head, as if ice lay there: 
nose, hands and feet cold ; irritable, weeping mood. 

2. Amenorrhea. 

Consists of the absence of menstruation in women between the 
ages of puberty and climaxis, with the exception of the periods 



AMENORRHEA. 779 

of pregnancy and nursing. The non-appearance of the menses at 
the age of puberty has its cause chiefly in chlorosis, scrofulosis, 
tuberculosis and rhachitis. Rarer are those cases in which it 
depends upon a degeneration of the ovaries ; more frequent those 
depending upon chronic infarctions or catarrhal processes of the 
womb in consequence of the above-stated constitutional diseases. 
It has been observed, likewise, as a consequence of spinal diseases, 
imperforation of the hymen, and closure of the os uteri. 

The cessation or suppression of the menses is usually a consequence 
of inflammatory processes, the causes of which have been detailed 
under the head of Metritis. 

Vicarious menstruation is that peculiar anomaly of the men- 
strual function, by which, at the regular monthly period, haemor- 
rhage takes place, not through the womb, but by means of some 
other mucous membrane (nose, lungs, bowels, ej'es, ears), from 
wounds and from telangiectasias. The reality of such abnormal 
action is established beyond any doubt. 

The Symptoms of amenorrhcea consist chiefly of headache, espe- 
cially on the top or on one side; heaviness of the feet; dyspnoea; 
dyspepsia; lassitude; sadness; sleepiness in the daytime; oedema; 
palpitation of the heart; epistaxis; hoemoptysis; hsematemesis; 
swelling of the veins on the lower extremities, in combination 
with all the constitutional signs upon which the whole disturb- 
ance rests as a basis. 

THERAPEUTIC HINTS.— Aeon., during puberty frequent bleeding 
of the nose; great palpitation of the heart; congestion of the 
head. After fright or taking cold. 

Apis, in young girls, who are constantly busily engaged in this 
or that, but do nothing right ; who let everything fall out of their 
hands or break it, and laugh over it; also great congestion of the 
head, and even delirium; cedematous swelling of the lower 
extremities. 

Apoc, in young girls, attended with bloating of the abdomen 
and extremities. 

Bellad., hsematemesis instead of the monthly discharge; con- 
gestion to the head. 

Bryon., bleeding of the nose instead of the monthly flow. 

Calc. carb., in young girls of a plethoric habit, or a scrofulous 
diathesis, with different complaints, as if the menses would set 
in, but do not; suppression of the menses from working in water, 
with anasarca. 



780 MENSTRUAL ANOMALIES. 

Carb. veg., at the time the menses should appear, violent itching 
of old tettery eruptions. t 

Caustic, epileptic fits during the time of puberty. 

China, after suppression by chagrin; secretion of milk in the 
breasts. 

Cimicif., in suppression from a cold, mental emotions and febrile 
symptoms; when rheumatic pains in the limbs, or intense head- 
ache, or uterine spasms are present. 

Coecul., instead of the monthly flow : cramps deep in the abdo- 
men; pressure in the chest; dyspnoea; groaning and moaning; 
great weakness, so that the patient is scarcely able to speak; 
paralytic feeling in the lower extremities. 

Cyclam.,' chlorotic state; great dizziness and headache. 

Cuprum, typical paroxysms of the most violent cramps in the 
abdomen, extending up into the chest, with nausea, retching and 
vomiting; convulsive motions of the limbs, with piercing shrieks. 

Digit, age of puberty; dark red, bluish color of the face; dis- 
tended veins on eyes, ears, lips and tongue; constant yawning; 
irregular action of the heart; suffocating feeling in bed; frequent 
desire to urinate; leucorrhoea; painful and swollen feet and 
limbs, with paralytic feeling in them. Bloody expectoration or 
nosebleed. 

Graphit., after Pulsat.; congestion of the head and chest; dark 
redness of the face; constriction of the chest, when lying, with 
anxiety; itching between the fingers, and tetters; nails grow 
thick and crooked; the limbs upon which she lies go to sleep. 

Hamam., vicarious bleeding from nose or stomach, with great 
constipation and varices on the legs. 

Kali carb., age of puberty; spasms of the chest; swelling of the 
face, especially over the eyes; stiffness and pain in the small of 
the back; dryness of the skin; is easily frightened: sleepless 
after 3 o'clock a.m., feeling worse in all respects at that time. 

Laches., nosebleed and cardialgia instead of menses. 

Lycop., suppression from a fright; great agitation of the blood 
in the evening, or a feeling as though circulation had ceased: 
great desire for sweet things ; sour belching ; great fulness in the 
stomach and bowels; liver spots on the chest. 

Mercur., cessation of the menses for several months; headache; 
weakness of sight ; nervous trembling of the hands ; earthy color 
of the face; prolapsus uteri; diarrhea with tenesmus; (edema- 
tous swelling all over ; tearing in the limbs, worse at night in 
bed, with constant sweating. 



AMENORRHEA. 781 

Millef., haemoptysis. 

Natr. mur., age of puberty ; melancholy and sadness, or hasti- 
ness and impatience ; awakes with headache ; has frequent flut- 
tering of the heart ; the tongue is covered with small blisters, or 
shows the appearance of a so-called map-tongue; the bowels are 
costive and move with great difficulty, and there is cutting pain 
in the urethra after urination. 

Phosphor., menses too late, or not appearing ; tight feeling in 
the chest, with dry, tight cough, and spitting of blood, worse 
before midnight; bloatedness below the eyes; a great deal of 
vertigo. 

Pulsat, age of puberty, or suppression, especially from getting 
the feet wet; nervous, timid, tearful disposition; always anxious 
about domestic affairs ; pale, yellowish color of the face ; dyspep- 
tic feelings from eating pork or anything fat; inclined to loose- 
ness of the bowels; thirstlessness and chilliness; always feels 
worse in a warm room ; haemoptysis, hsematemesis. 

Rhus tox., suppression from getting wet. 

Senecio gracilis, suppression ; inability to sleep, nervous irrita- 
bility ; loss of appetite ; coated tongue ; bowels constipated ; con- 
stant feeling of lassitude ; disinclined to move about ; wandering 
pains in back and shoulders. Is called "the female regulator." 

Sepia, age of puberty or later; headache, with nausea; jerking 
with the head ; paralytic sinking down of the eyelids ; yellowness 
around the mouth, across the cheeks and nose ; loathing of all 
food, even the smell of cooking nauseates her ; nausea when rid- 
ing in a carriage ; diarrhoea after drinking milk ; cold hands and 
cold feet, with frequent flushes of heat to the head and face ; pot- 
belliedness. 

Sulphur, great congestion to the pelvic organs and to the head ; 
cold feet, and heat on the top of the head ; the patient is very 
irritable, and inclined to religious reveries ; chronic inflammation 
of the eyelids, or other psoric eruptions ; dreads to wash with cold 
water ; feels exhausted from talking ; all worse when standing ; 
sleepy in the daytime ; sleepless at night ; great agitation of the 
blood in the whole body. 

Xanthox., after getting the feet wet ; nauseated by the sight of 
food ; constipated, nervous, discouraged ; shortness of breath ; 
legs swollen. (J. W. Davis.) 



782 MENSTRUAL ANOMALIES. 

3. Dysmenorrhea, Menstruatio Difficilis. 

We understand by this, painful menstruation, without regard to 
the quantity of blood discharged, though in most cases the men- 
strual flow is scanty. 

The different complaints accompanying it set in either before 
or at the time when the menstrual discharge begins, and gener- 
ally last a day or two, and sometimes through the whole men- 
strual period. 

We distinguish, according to its causes, three forms of dysmen- 
orrhcea : 

1. Dysmenorrhcea in consequence of structural changes or flexions 
of the uterus, which has been termed by some writers mechanical 
dysmenorrhea; compare the related chapters. 

2. Dysmenorrhcea in consequence of congestion in the uterus, 
or congestive dysmenorrhea; it usually commences with all the 
signs of congestion to the pelvic organs — strong action of the 
heart, congestion of the head, and febrile motions in general. 
These symptoms continue one, two, or three days, until a more 
profuse discharge of blood has taken place. Not only plethoric 
individuals are prone to it, but also weakly and anaemic individ- 
uals. It is possible that, in some instances, this congestive state 
is induced by a thickened state of the peritoneal covering of the 
ovaries, and the consequent difficult perforation of a Graafian 
follicle. Very violent congestion may cause an exudate between 
the mucous lining and the parenchyma of the uterus, in conse- 
quence of which portions of the loosened membrane are thrown 
off and discharged — membranous dysmenorrhea. 

3. Dysmenorrhcea in consequence of a morbid sensibility of the 
nervous system in general and the uterine nerves especially, or neural- 
gic dysmenorrhea. This manifests itself as a disturbance in the 
healthy equilibrium of the mind's action and a dejection of spirits, 
which commences even before the menses; the menses are at- 
tended at their beginning with distressing pains in the uterine 
region, in the back, and lower extremities, or with neuralgic 
pains in more distant organs, or with cramps, spasms, etc. It is 
quite possible that in some cases the violent, spasmodic, labor- 
like pains in the womb are caused by a spasmodic closure of the 
os uteri. 

THERAPEUTIC HINTS.— Compare the foregoing chapters, and 
likewise those on Metritis and Displacements of the Womb. 



DYSMENORRHEA. 7S3 

Aeon., congestive type, with violent backache; labor-like press- 
ing in the womb; headache; restlessness; necessity to bend 
double on account of pain, but finds no relief in any position ; 
tossing about. 

Amm. carb., cramp-like pain in the womb before the flow, with 
pallor of face. (Talbot.) 

Apis, congestive type; violent, labor-like, bearing-down pains, 
followed by discharge of scanty, dark, bloody mucus ; stinging- 
pain in the ovaries ; scanty, dark urine ; wax-colored skin. 

Arsen., attended with various kinds of complaints ; lancinations 
from the rectum to the anus and pudendum ; toothache ; restless- 
ness ; fear of being left alone ; the pains are worse about mid- 
night, seem intolerable, drive to despair and frenzy ; external 
application of warmth relieves. 

Asclep. syr., neuralgic type; intermitting, bearing-down, labor- 
like pains, accompanied with a copious discharge of urine. 

Bellad., congestive and neuralgic type ; violent bearing down, 
as if everything would issue out; violent throbbing headache, 
better from external pressure ; throbbing toothache ; enlarged 
pupils; throbbing carotids; drowsiness and inability to go to 
sleep ; spasmodic twitchings ; delirium ; rage ; frenzy ; wants to 
bite ; tries to escape, etc. 

Bromium, violent contractive spasms some hours after the com- 
mencement of the menstrual flow, with subsequent soreness in 
the abdomen ; loud emissions of flatulence from the vagina ; 
hard swelling in the ovarian region ; blue-eyed persons. 

Bryoii., congestive type ; tearing in all the limbs, aggravated by 
motion ; great thirst, white tongue; constipation, or diarrhoea in 
the morning ; great irascibility. 

Calc. carb., various complaints; toothache after the menses; 
nervous debility ; pale bloatedness of the face ; cannot bear any- 
thing tight around the waist ; stiffness of the nape of the neck ; 
pain in the back ; cold hands and feet ; sensitiveness to cold air ; 
bad consequences from washing ; scrofulous individuals. 

Cact. grand., menstruation with most terrible pains, causing 
her to cry out aloud and to weep ; the pains come on periodically, 
mostly in the evening ; the menses are scanty and cease flowing 
when lying down ; constrictive pain in the region of the heart, a 
feeling as if the heart were grasped and compressed, as by a band 
of iron. 

Cauloph., painful contractions, congestion and irritability of the 



784 MENSTRUAL ANOMALIES. 

womb ; scanty flow ; sympathetic cramps in the bladder and rec- 
tum ; hysterical spasms of chest and larynx. 

Chamom., neuralgic type ; drawing, clawing pain from back to- 
wards front, with discharge of dark, clotted blood ; great impa- 
tience, with crying and screaming ; bloated, red face, or one side 
red and the other pale ; hot, sticky perspiration on the forehead ; 
after chagrin. 

Cimicif., aching in the limbs ; severe pains in the back, down 
the thighs and through the hips, with heavy pressing down ; 
labor-like pains; weeping mood; nervousness; hysteric spasms, 
cramps ; tenderness of the hypogastric region ; scanty or profuse 
flow of coagulated blood ; between the menses, debility, neuralgic 
pains, tendency to prolapsus. 

Coccul., cramp-pain deep in the bowels, instead of the monthly 
with pressure in the chest, and anxiety, sobbing, moaning and 
groaning; great weakness and fainting spells; convulsive mo- 
tions of the limbs whenever she wants to use them ; after night- 
watching. 

Collin., when complicated with obstinate constipation, piles and 
prolapsus. 

Coloc, she draws the lower limbs up to the abdomen, to relieve 
the colicky pain ; diarrhoea after indignation. 

Conium, scanty menses; pressing downwards and drawing in 
the thighs ; pain in the mammae ; suppressed sexual instinct ; 
hysteric globus in the throat ; vertigo, especially when turning 
the head or lying down. 

Cuprum, typic paroxysms of terrible cramps in the stomach, ex- 
tending to the chest, with nausea, retching and vomiting ; also, 
general epileptiform spasms, with piercing shrieks : great thirst : 
on swallowing any fluid there is an audible clucking noise in the 
throat, like that of emptying a bottle. 

Graphit., scanty menses, with crampy pains in the bowels and 
chest, and labor-like pressing in the small of the back : she is full 
of despairing grief, with weeping ; always wavering and hesitat- 
ing; has vertigo unto falling, and headache unto fainting, in the 
morning; pimply eruptions on the face about the monthly period; 
tettery eruptions, especially between the fingers, with great itching. 

Hamam., severe pains through the lumbar and hypogastric re- 
gions, and down the legs ; fulness of the bowels and brain, with 
severe pain through the whole head, resulting in stupor and 
deep sleep; varicosed veins on the legs; vicarious menstruation. 



DYSMENORRHEA. 785 

Laches., tearing in the abdomen, beating in the head, pain in 
the small of the back, and bruised feeling in the hips ; all re- 
lieved by a full flow; bleeding of the nose before the menses; 
jealous disposition ; craves coffee, and feels better after drinking 
it ; ulcers on the legs, with a purplish circumference. 

Lauroc., pain extending from sacrum to pubis; frontal head- 
ache, with dizziness and dimness of vision; great melancholy; 
icy coldness of tongue, and coldness of extremities. (Osborn.) 

Magn. carb., during the pain no flow ; flow more during night 
than during day ; the blood is dark, acrid and thick ; violent 
neuralgic pain in the face, right side, driving out of bed ; or pain 
in the right shoulder or in the foot. 

Natr. mm*., menses scanty and dark ; preceded by frontal head- 
aches ; often subject to fever-blisters on lips, and during summer 
to urticarious eruptions. (R. E. Bilding.) 

Nux mosch., after suppression by bathing ; fainting from pain ; 
drowsiness, somnolence; changeable mood; does not know where 
she is; appears to herself as if changed to her surroundings; 
hands and feet icy-cold. 

Nux vom., twisting pains moving. about in the abdomen, with 
sickness of the stomach ; crampy and stitching pains in the pel- 
vic region ; soreness across the pubis ; cramps in the bladder ; 
constant, unsuccessful urging to defecate ; after all sorts of drugs 
and so-called pain-killers. 

Phosphor., colicky pains ; great fermentation in the bowels ; a 
great deal of vertigo; chronic looseness of the bowels; or chronic 
constipation, with dry, narrow feces ; slender-built women. 

Platina, great bearing down to the genitals, with profuse men- 
struation; great fear of death; sadness and disposition to cry; or 
haughty disposition ; tetanous-like convulsions. 

Pulsai, colicky pains, with tossing about; the blood flows by 
fits and starts ; chilliness ; thirstlessness ; hsernoptoe or hsemate- 
mesis ; paleness of the face ; mild, yielding, tearful disposition. 

Senecio, cutting pains in the region of the sacrum, hypogas- 
trium, and groins, with too early or too profuse menses ; she is 
pale, weak, and nervous, and has a slight cough at night. 

Sepia, colicky pains and scanty discharge ; great bearing down, 
which obliges her to cross the limbs ; morning sickness and great 
sensitiveness against any smell from cooking; toothache; half- 
sided headache ; nausea ; constipation. 

Sulphur, scanty menses of a thick, acrid blood; crampy colic; 

50 



786 VAGINA. 

terrible, neuralgic pains in the face; much concerned about her 
salvation; congestion to the head and heat on the top of it; 
spotted redness of the face; cold feet; standing increases the 
pains; chronic eruptions here and there. 

Tarant, before menses bearing-down pain ; fidgety of legs ; must 
move about; better on riding horseback; during menses all worse 
with chorea-like restlessness, trembling and twitching of muscles. 
(P. Bender.) 

Viburn. op., before menses pain in back, gradually extending to 
hypogastric region and down the thighs ; headache with nausea 
and uneasiness; cramps and bearing-down before discharge ap- 
pears, lasting till after the flow has ceased. (J. C. King.) 

Xanthox., neuralgic fever with pain along the course of the 
genito-crural nerve. (E. F. Blake.) Abundant discharge. 

VAGINA. 
Catarrh of the Vagina; Vaginitis. 

Like all other catarrhal affections of mucous membranes, it is 
characterized by redness, swelling and increased secretion of 
mucus. There are here and there little protuberances, which 
consist of swollen papilla? of the mucous membrane; it invests 
either a part of the vagina, or extends all over the organ. The 
secretion is at first scanty, but by degrees becomes more profuse 
and opaque. In chronic cases we find the vagina relaxed, its 
mucous lining bluish red, and studded with swollen papilla?. 
This relaxation not unfrequently leads to prolapsus vagina?. The 
secretion is in such cases milk}-, more or less yellow, and some- 
times of other appearances. It constitutes what is commonly 
called leucorrhoea, which is frequently the only sign of the exist- 
ing trouble. 

Its Causes are like those of the uterine catarrh, as recorded in 
their respective chapters; it is of quite rare occurrence during 
childhood, in which case it may be induced by the little thread- 
worms (oxyures) creeping from the anus across the perineum 
into the vagina. 

THERAPEUTIC HINTS.— Compare Uterine Catarrh. 
The virulent catarrh of the vagina is spoken of in the chapter of 
Gonorrhoea. 



PRURITUS VULV.E. 787 

Pruritus Vulvae 

Is frequently a mere symptom of other diseased conditions of 
the sexual organs. We find it in the beginning of pregnancy, 
and also before the menstrual flow; but its most intense forms 
occur during the climaxis, especially of unmarried women. The 
itching is so intolerable and distressing that it takes away all 
sleep and rest, and causes a number of nervous complaints. 
Physical examination generally reveals no particular change of 
the parts, except perhaps some dryness of the vagina or slight 
eruptions on the labia. Such persons are often subject to heem- 
orrhoidal complaints, and it is possible that this terrible itching 
is dependent upon a stagnation of blood in the vaginal veins. 

THERAPEUTIC HINTS.— Ambra, during pregnancy, with soreness 
and swelling of the parts; numb feeling of the whole surface of 
the body in the morning; perspiration of the abdomen and thighs 
in the daytime when moving about; falling out of the hair, and 
great sensitiveness of the scalp to the touch. 

Caladium, according to the experience of others and my own 
the most efficient remedy; the terrible itching sometimes causes 
the habit of onanism. 

Calc. carb., itching and soreness; offensive discharge from the 
ears; cold in the head, with soreness inside of the nose; scrofu- 
lous taint. 

Canthar., climacteric age ; from rubbing and scratching, the 
skin swells into little tumors ; urinary difficulties. 

Carb. veg., itching and burning of the pudendum and anus, 
especially before the menses ; itching, tettery eruptions on the 
body ; leucorrhcea, with burning and soreness ; haemorrhoids. 

Collin., distressing itching, in connection with prolapsus and 
constipation. 

Conium, violent itching of the pudendum and vagina, espe- 
cially after the menses, followed by a pressing downwards of the 
uterus. 

Lycop., itching, burning and gnawing, with chronic dryness of 
the vagina ; varicose veins. 

Natr. mar., falling out of the hair on the mons veneris; dryness, 
or coolness and paleness of the vagina ; aversion to an embrace ; 
eruption on the boundaries of the hair on the neck. 

Nux vom., tingling and itching in the parts, which excites sex- 
ual desire and induces onanism. 



788 MAMM.E. 

Platina, when the sexual desire is greatly augmented, even to 
nymphomania. 

Sepia, swelling and itching eruption on the inner labia; leu- 
corrhcea, with itching in the vagina and pudendum ; ringworm- 
like eruptions on other parts of the body. 

Sulphur, itching in the vagina and pudendum, with pimples 
all around ; itching of the nose after menstruation ; itching of 
the nipples ; pimples here and there ; haemorrhoids. 

Tarant, dryness and heat of the parts. 

Zincum, excessive itching during the menses, inducing mastur- 
bation. 



MAMlVLffi. 

Mastitis, Inflammation of the Breasts. 

It develops itself chiefly during the period of nursing, and 
usually at the commencement; less frequently, during weaning. 
Its cause is stagnation of milk within the gland or a tube of the 
gland, induced by sore or imperfect nipples; or weakness of the 
child, in consequence of which the breasts are not thoroughly 
emptied of their contents; or undue, pressure exercised upon the 
gland by misfitting dresses, producing obstructions in single 
tubes of the gland and final inflammatory symptoms. Here 
then we have an inflammation of the milk-ducts of the mammae, 
which commences within and spreads outward. In other cases 
the inflammation begins in the subcutaneous cellular tissue; a kind 
of erysipelatous inflammation, spreading inward, and caking a 
portion of the breast. This form may be caused by external 
injuries, bruises, exposure to cold, and by fright; or it may be 
the result of the spreading of the above-named inflammation of 
the milk-ducts. 

It is a most painful affection in either case, and frequently 
results in the formation of abscesses. 

THERAPEUTIC HINTS.— Apis, burning, stinging pains in the 
breast; considerable swelling and hardness: erysipelatous in- 
flammation. 

Arnica, soreness of the nipples; bruises of the breast. 

Bellad., during nursing and weaning, great hardness and swell- 
ing; bright redness in streaks along the milk-ducts; throbbing, 



stitching pain ; headache; fever; worse in the afternoon ; bowels 
constipated, and urine scanty. 

Bryon., sets in mostly with a chill, followed by fever; great stitch- 
ing pain in the breast, worse from slightest motion ; tense swell- 
ing; little or no redness; bursting pain in the head when rising, 
with dizziness; great thirst; thick-coated tongue; constipation; 
feces as if burnt ; pain in all the limbs when moving. 

Graphit, inflamed, cracked nipples; tettery eruptions on the 
scalp, hands and between the fingers; indurated Meibomian 
glands ; old cicatrices from former inflammations. 

Hamam., bleeding nipples, with great soreness. 

Hepar, pain in the upper arms and thighs, as if in the bones ; 
great hastiness in drinking and speaking ; also in persons who 
have taken a great deal of mercury ; when suppuration commences 
with frequent crawls, or when, after the breaking or opening of 
the abscesses (which latter, indeed, never ought to be done) the 
discharge is scanty, and there still remains great hardness of the 
inflamed parts. 

Laches., when the inflamed breast has a purplish appearance. 

Mercur., especially when after Bellad., notwithstanding, suppu- 
ration sets in ; chilliness and profuse sweat, which does not re- 
lieve ; great nervous weakness and trembling ; also in cases where 
suppuration takes place in different parts of the breast. 

Nux vom., nipples painful during suckling, with little or no 
soreness or rawness. 

Phosphor., phlegmonous inflammation ; breast swollen ; red in 
spots or streaks; hard knots in different places, with fistulous 
opening, discharging a watery, discolored, offensive ichor ; dry, 
hacking cough, with hectic fever and colliquative sweats ; slender- 
built women, with a white and tender skin ; weakened by disease 
or loss of fluids. 

Phytol., sore and fissured nipples, with intense suffering when 
putting the child to the breast ; the pain seems to start from the 
nipple and irradiate all over the body, going to the backbone, 
and streaking up and down, with excessive flow of milk, causing 
great exhaustion ; a few days after confinement sudden chill, fol- 
lowed by some fever and a painful engorgement and swelling of 
the mammae ; the drawing of milk is impossible. In ordinary 
caked breasts it is called specific. Badly-treated " gathered breasts," 
with large, fistulous, gaping and angry ulcers, filled with un- 
healthy granulations and discharging a watery, fetid, ichorous 
pus ; the gland is full of hard, painful nodosities. 



790 MAMM.E. 

Rhus tox., soreness and swelling of the breast from taking cold, 
especially getting wet ; pain in all the limbs ; worse when at rest; 
great restlessness ; the lochial discharge turns red again. 

Silic, chronic cases ; when Phosphor, is not sufficient to heal 
the fistulous opening, with callous edges, or to disperse the hard 
lumps in the breast ; pale, earthy color in the face ; loss of smell ; 
hectic fever. 

Sulphur, sore and cracked nipples, with bleeding when nursing; 
the areolae are covered with yellowish scales, from underneath 
of which oozes an acrid fluid, with itching and burning in the 
night ; hard lumps in the breast ; ulcerating sore, with spongy 
excrescences and great itching ; sleepless nights. 

Scirrhus seu Carcinoma Mammae, Scirrhus, or Cancer of 
the Breast. 

The scirrhous form is the most frequent ; it appears either deep 
in the gland or nearer the surface, as a roundish tumor, which 
draws the region of the nipple inward, causing a navel-like de- 
pression by its gradually degenerating the surrounding tissue, 
and its adhesion to the external skin. Its development is slow, 
but terminates finally in a deep ulcer, with callous, exuberant 
edges, a foul, fungous opening. 

The medullary cancer is of rare occurrence. It appears as one 
or several tumors, which destroy in a short time the surrounding 
parts of the gland, by ulcerating and producing fungous growths. 

The development of cancerous growths rest upon a constitu- 
tional contamination, the nature of which we do not know. Its 
development is, in most cases, slow, often intermitting, making 
halts for a long time. Finally, it perforates the skin, and appears 
as an open cancer, making rapid strides to final destruction. 

It is generally found in one breast at a time; sometimes in 
both, and often combined with scirrhous degeneration in other 
parts of the system. It causes the most intense, burning, sting- 
ing, lancinating pains, which deprive the patient of sleep and 
rest. The open ulcer discharges profusely an offensive ichor, or 
it bleeds easily and profusely when, by erosion, blood-vessels 
become destroyed. The nutritive action of the system is com- 
pletely prostrated, and we see the patient gradually lose strength 
and sink, with symptoms of marasmus, oedema of the lower ex- 
tremities, colliquative diarrhoea or a sudden profuse haemorrhage 
from the ulcer. 



SCIRRHUS. 791 

THERAPEUTIC HINTS.— Apis, when there is stinging, burning 
pain, whether in scirrhous tumors or in open cancers; pain in 
the ovarian region, with bearing down; scanty, dark urine; 
oedema of the lower extremities. 

Arsen., nightly, burning pain like fire, with great restlessness; 
loss of strength and emaciation; the pains grow better from the 
external application of warmth. 

Ars. jod., with swelling of gland in axilla. 

Asterias rub., recommended by Petros for cancers of the left 
breast. 

Badiaga ought to be thought of, at least. 

Bellad., scirrhous tumors, with erysipelatous inflammation and 
stitching pain ; frequent bearing down in the genital organs. 

Bromium, after the extirpation of a hard tumor in the left 
breast, there appears a hard, uneven tumor in the right breast, 
which is grown tight to its surroundings ; periodical lancinating 
pains, especially at night, worse from external pressure ; grayish, 
earthy complexion of the face ; suppression of menses ; emacia- 
tion, and great depression of spirits. 

Calc. carb., indurations of the breast ; too early and too profuse 
menstruation ; soreness and swelling of breast before the menses. 

Calc. ox., has, more than any other remedy, relieved the terrible 
pains in open cancers. 

Carb. an., scirrhous tumor, hard and uneven ; the skin over it 
is loose, on places of a dirty, blue-red appearance ; the pains are 
burning and drawing toward the axilla; oppression of the chest; 
nightly perspiration of the thighs only ; desponding. 

Chim. limb., tumor broke and left a small, irregular ulcer, with 
worsted edges, sloughing, discharging fetid pus ; axillary glands 
enlarged. (E. S. Coburn.) 

Clemat, scirrhus, left side, with stitches in the shoulder; or 
when the whole gland is very painful, worse in cold weather 
and during the night ; worse during the growing moon ; while 
perspiring, she cannot bear to be uncovered. 

Connim, particularly, if the origin of the tumor can be traced to 
a bruise ; starting, lancinating pains. 

Grapbit, when the tumor grows out of old cicatrices, which 
have been formed by repeated gatherings of the breast. 

Hydrast, scirrhous tumor; hard, heavy, and adherent to the 
skin, which is dark, mottled, and very much puckered ; the 
nipple being retracted ; pains like knives thrust into the part ; 
cachectic appearance of the face. 



792 MAMJtLE. 

Laches., tumor in left breast, with lancinating pain ; in conse- 
quence of pressure upon the tumor the pain extends into the left 
shoulder and down the arm ; there is a constant painful feeling 
of weakness and lameness in the left shoulder and arm, which is 
aggravated by using the arm. In open cancer, when it has a 
dark, bluish-red appearance, with blackish streaks of coagulated 
and decomposed blood ; chronic leucorrhoea ; painful menstrua- 
tion on the first day. 

Lapis alb., recommended by v. Grauvogl. 

Lycop., hard tumors, with stitching or cramping pain ; circum- 
scribed redness of the face ; worse from 4 o'clock p.m. ; during 
the paroxysms of pain she is obliged to walk about and to weep ; 
she feels better in the open air. 

Phosphor., when the ulcer bleeds easily. 

Sepia, indurations in the breast and ovaries; yellow, spotted 
face ; chronic leucorrhoea. 

Silic, with great itching of the swollen gland. (J. B. Bell.) 

Compare besides, Aur. mur., Baryta, Chamom., Carb. veg., 
Cistus, Hamam., Hepar, Nitr. ac, Natr. mur., Phytol., Rumex, 
Sulphur, Thuja, Zincum. 



SPINE. 



Anaemia 

Is a diminution in the amount of blood contained in the cord, 
either in consequence of an insufficient supply of arterial blood, 
or in consequence of general anemia. The insufficient supply 
may be due to weakness of the heart's impulse, to compression, 
thrombosis or embolism of the abdominal aorta, or of certain spinal 
arteries. General aneemia may be the consequence of great loss of 
blood, severe acute diseases, inanition, etc. 

Embolism of the aorta is usually followed by a rapid palsy of 
the legs, sphincters, reflex function, etc. ; while in compression of 
the aorta the symptoms of paralysis keep pace with the gradual 
development of the constriction. Anaemia caused by thrombosis 
and embolism of small arteries, gives rise probably to mere local 
and subordinate symptoms, of which nothing is known defi- 
nitely. 

If general anaemia be the cause of spinal anaemia, the symp- 
toms of the latter will be so covered by the general complex of 
symptoms, that it will be hard to say what belongs to the one or 
the other, although motor weakness and slight tremor after ex- 
ertion, later paresis and finally paralysis, first of the lower limbs 
and extending upwards to trunk and arms, may be attributed to 
spinal anaemia. The symptoms usually are relieved in a hori- 
zontal position. 

THERAPEUTIC HINTS.— We will have to consider the various 
causes. There may be indicated: Arsen. , Calc. carb., China, 
Cimicif., Ferrum, Gelsem., Ignat., Nux vom., Phosphor., Phosph. 
ac, Secale, etc. 



794 



Hyperemia 



Is an increase in the amount of blood contained in the spinal 
cord and membranes, either in consequence of congestion (active 
or artificial fluxion) or stagnation (venous stasis). 

Congestion may be produced by overstimulation of the cord — 
from overwork, severe marching, sexual excesses, etc. ; by poison- 
ing with strychnia, nitrate of amyl, carbonic acid, alcohol, ab- 
synthe, etc.; by collateral fluxion in consequence of the suppres- 
sion of menses, hsemorrhoidal bleedings, foot-sweat, etc., or tak- 
ing cold in general ; by falls and bruises ; and by febrile dis- 



Venous stasis finds its causes in diseases of the heart and lungs, 
in obstructions of the portal system, and accompanies severe 
spasmodic affections, such as tetanus, eclampsia, etc. 

The symptoms of spinal hypersernia are, without exception, 
bilateral, and usually limited to the lower limbs ; they change 
their seat and degree of severity frequently and quickly, and are 
often relieved in a horizontal position. They consist at times of 
pain in the loins and along the spine, or of tingling, formication, 
or tearing pain in the lower extremities ; of hyperesthesia of the 
skin, girdle sensation and transitory jerking of the muscles, and 
trembling of the limbs. At other times we find symptoms of de- 
pression, such as numbness and heaviness of the lower limbs and 
slight anaesthesia. 

THERAPEUTIC HINTS.— Congestion may require: Aeon., Arnica, 
Arsen., Bellad., Cuprum, Hyper., Nux vom., Rhus tox., Sulphur, 
etc. Venous stasis : Compare heart and lung diseases ; abdomi- 
nal disorders. 



Apoplexy, or Extravasation of Blood 

Within the spinal canal. This may take place between the ver- 
tebrae and the dura mater, or between the different spinal mem- 
branes, or within the spinal marrow itself. It is, compared with 
apoplexy of the brain, of very rare occurrence. This may have 
its reason partly in the peculiarity of the structure of the spine, 
and its circulation, having numerous outlets and inlets, thus 
giving less occasion for stagnation in the circulation ; and partly 
in the greater security with which a long cord like the spinal 



APOPLEXY. 795 

marrow is held by its membranes, than a larger bulk, like the 
brain. 

1. Meningeal apoplexy, being an extravasation of blood between 
the spinal membranes, shows, when anatomically examined, a 
collection, usually, of dark, coagulated, seldom fluid, blood, 
which extends over a smaller or larger surface within the spinal 
cord, sometimes filling the whole spinal column. 

Its Causes are manifold. The blood may, in consequence of 
apoplexy of the brain, or in consequence of the rupture of aneu- 
rismatic swellings of blood-vessels in the brain, percolate into the 
spine. Its most frequent causes, however, are external injuries, 
either from excessive bodily exertions, or a fall, blow or wound, 
or diseases of the vertebrae. Trismus and tetanus seem to cause 
it secondarily. 

Symptoms. — If it sets in suddenly, the patient falls down, as in 
an apoplectic fit, but without loss of consciousness or sense. If it 
develops slowly, it commences usually with headache and pain in 
the spine in the region of the exudation, which radiates in vari- 
ous directions, usually corresponding to the distribution of the 
nerve-roots first attacked; there is also formication, burning, 
tingling, etc., in the same regions, and characteristic jerkings of 
the muscles, occasionally increasing to convulsions, trembling of 
the extremities, tonic tension and contracture of various groups 
of muscles, and tetanic stiffness and painfulness of the back, 
making it difficult or impossible for the patient to move. After 
this, especially in large effusions, we observe numbness, pithi- 
ness, sensations of swelling and heaviness in the limbs and 
trunk, which may increase to paresis or even paralysis of the 
parts which are governed from the spot affected. 

If the cervical region is affected the attack begins with pain in 
the occiput, shoulders and arms, and stiff neck; anaesthesia and 
paralysis of upper extremities ; oculo-pupillary symptoms ; diffi- 
culty of breathing and swallowing ; violent dyspnoea ; retarded 
and weak pulse. If in the dorsal region, we have pain in the 
back and abdomen, and pain in the form of a girdle ; stiffness of 
the back ; paralysis of the legs and abdominal muscles. If in 
the lumbar region, there is pain in the loins, tearing in the lower 
limbs, perineum, bladder, and genitals; stiffness of the loins; 
paralysis of the lower limbs, of bladder and rectum. 

2. Medullary apoplexy, an effusion of blood within the spinal 
marrow itself, is found chiefly in the gray substance of the mar- 



row and of various extent. It may be no larger than a pea, and 
it may reach the size of a hazlenut or an almond. Such effu- 
sions have been found most frequently in the cervical, less fre- 
quently in the dorsal, and least frequently in the lower portion 
of the spine. 

Its Causes are chiefly inflammation, softening, or other lesions 
of the marrow which precede it. In some cases it seems to have 
been produced by external injuries, (fall, concussion, with or 
without fracture or luxation of the vertebrae, surgical operations) 
or by active congestion from taking cold, sexual excesses, overex- 
ertions of the body, etc. 

Symptoms. — As premonitory signs we find numbness in the 
fingers and in the feet; after exertion, great weakness and stiff- 
ness of the nape of the neck, extremities, or of the whole body. 
Its existence is characterized by a Joss of voluntary motion, which 
may come on suddenly or in the course of a short time more 
gradually. This paralysis affects all the parts which receive 
their nerves from that portion of the spine below the lesion, and 
it is always found on both sides. The paralyzed muscles are 
perfectly lax. 

Like motion, so is also sensation more or less impaired. The 
parts below the lesion become on both sides insensible to touch 
or partially so. If paraplegia lasts for some time it causes the 
limbs to shrink, and brings on gangrenous bed-sores, sometimes 
quite rapidly. 

A lesion higher up affects the actions of respiration and deglu- 
tition, and the nearer to the medulla oblongata the more so, caus- 
ing cessation of respiration and consequent death by asphyxia. 

Effusions in the dorsal and lumbar regions may exist for years, 
and if not too extensive may allow even a partial recovery. 

THERAPEUTIC HINTS.— The causes will hint to the appropriate 
remedies. Compare the foregoing chapters. 

Guaco is, according to Dr. Erb, a specific for paralysis of the 
tongue and extremities in consequence of bloody extravasation 
within the spine. 



Spinal Irritation. 

This complaint has by some been stricken out of the nomen- 
clature of special diseases ; Hammond considers it due to spinal 



SPINAL IRRITATION. 797 

anxmia, especially of the posterior columns, probably dependent 
upon some derangement of the sympathetic system ; Ollivier and 
others consider it due to spinal hypersemia and still others look 
upon it as a dynamic disease, a functional disorder of the spinal 
cord, as there does not exist a pathological anatomy of spinal 
irritation. Nevertheless a certain group of symptoms, frequently 
found in women, seems to demand a separate consideration of 
spinal irritation, even if it be but a dynamic disturbance of the 
spinal cord. 

Its most prominent Symptoms are: Pain and discomfort in the 
back, most frequently between the shoulder-blades, next in the 
back of the neck, less frequently in the loins, always increased 
from bodily exertions. The sore or sensitive spot or spots of the 
spine are easily detected by pressure, tapping, the passage of a 
hot sponge down the spine and other irritations; at other times 
the pain is deep-seated and is produced by pressure upon verte- 
brae which are not sensitive, also by movements of the spinal 
column, by standing, etc. With these pains in the spine are fre- 
quently associated neuralgic pains in different parts of the body, 
sometimes fleeting, sometimes more stationary. There is usually 
great weariness and exhaustion upon slight efforts, so that walk- 
ing or manual occupations, such as sewing, writing, piano-play- 
ing, etc., soon become unbearable on account of the pains they 
excite in back and limbs. Spasmodic symptoms, such as twitch- 
ings, choreoid movements, singultus, etc., are often observed, and 
disturbances in the vegetative organs — belching, nausea, vomiting; 
palpitation of the heart, dyspnoea, spasmodic cough, frequent 
desire to urinate, with abundant discharge of pale, clear urine — 
are frequently met with ; numbness, tingling, and paretic symp- 
toms are of less frequent occurrence. The patients are irritable, 
depressed and often sleepless; they complain of dizziness, noise 
in ears and an inability to read for any length of time; their 
hands and feet are usually cold and they flush easily. 

Spinal irritation, if located in the cervical region, causes head 
and chest symptoms, if in the dorsal region, intercostal neuralgia, 
gastralgia, nausea, etc., if in the lumbar region, symptoms of the 
pelvic organs and lower extremities; and if diffused, symptoms of 
all kinds in peripherical organs. 

Spinal irritation is of no stated duration; it may last for years 
with many fluctuations. 



798 spine. 

THERAPEUTIC HINTS.— A great number of remedies may be 
indicated and the treatment must be wholly symptomatical. The 
following remedies have proved successful in actual cases. 

Act. rac, constant nausea and retching on pressure upon the 
spine, between the fourth and fifth vertebra; frequent fainting; 
palpitation on least movement; amenorrhcea. 

Bellad., on pressure upon the dorsal vertebrse she cries out, gets 
pale, nauseated and belches wind; in the spine continual burn- 
ing pain ; stomach sore to touch, with nausea and vomiting after 
eating. Or, sudden shriek on pressure upon the fourth dorsal 
vertebra, followed by a dry, violent cough, red face, headache in 
forehead, photophobia and perspiration. 

CoccuL, stiffness of neck; pain in lower portion of spine; op- 
pression of chest; palpitation of heart; trembling of limbs; 
numbness of right upper and lower limb. (Small.) Great hy- 
peresthesia of all the senses, and an exalted susceptibility to 
impressions; dreadful headaches, sleeplessness; when her mind 
is turned away from herself, her sufferings are forgotten. (C. W. 
Boyce.) 

Hyper., tenderness of entire spine ; paroxysms of pain in differ- 
ent joints, accompanied hv mania; frightful illusions; attempt- 
ing to hide from wild beasts; screaming if approached ; no recol- 
lection of the attack; appeared as if just aroused from sleep. (A. 
L. Dornberg.) 

Natr. mur., headache on waking in the morning; sleeplessness; 
constipation; salty taste and repugnance to food ; trembling sen- 
sation in region of heart. Vision becomes dim and indistinct 
after reading a while; eyes sore on pressure upon them; occa- 
sional neuralgia in forehead, with nausea and sensitiveness of 
eyes to gaslight; at times only one-half of an object is visible; 
black spots and streaks of light before eyes; easily fatigued; 
weakness from slight exertion; restlessness of the limbs; pain in 
back and sensitiveness of spine. (Burr.) 

Piper meth., pain in the back of the head and spine, and relief 
from all sufferings temporarily by change (mental or physical), 
slight excitement, or diversion of the mind to some other topic. 

Rhus tox., violent pain in head from back to front, and down 
the spine; lies on her back; head and back drawn backward, 
the slightest touch or move causes excruciating pain. Pulse 
slow; obstinate constipation; complete sleeplessness; pain in 
paroxysms. After getting wet, (Dittrich.) 



NEURASTHENIA SPINALIS. 799 

Secale, tenderness of lower cervical and upper dorsal spinous 
processes, with stiffness of neck. Pressure upon it produces pain 
there and all through the chest, with irritation to cough. 

Tarant, a slight touch along the spine provokes spasmodic 
pains in the chest and indescribable distress in the cardiac 
region; at times the heart feels as if twisted over; intense head- 
ache, as though thousands of needles were pricking into the 
brain; sensation of burning all over the body. She trembled so 
she could hardly talk. Headache relieved by rubbing the head 
against the pillow. (Farrington.) 

Neurasthenia Spinalis; Spinal Nervous Weakness. 

Like spinal irritation, so is spinal weakness a functional disease 
without a demonstrable pathological basis; but it is predomi- 
nantly an affection of the male sex. Its direct causes are excessive 
mental efforts, severe mental toil at night, great mental excitement 
from grief, affections, passions, etc., excessive sexual indulgence, 
onanism, etc., severe exhausting diseases. 

It manifests itself in a striking weakness and rapid fatigue, espe- 
cially of the lower limbs, from any little exertion in walking or 
standing; in pain in the back, which shifts about from different 
kinds of motion, or is brought on by slight exposure to cold ; in 
pains of the extremities, which are associated with the fatigue occa- 
sioned by any little exertion; in sexual irritable weakness, by 
which, during coition, the semen escapes too quickly and the act 
is followed by great prostration; in sleeplessness for several hours 
in the night after a first sleep ; in a general sense of illness, hypo- 
chondriacal feelings, and often a womanish disposition; in cold 
hands and cold feet. With all this there is an absence of any 
kind of disturbance in the natural motility of the limbs and their 
sensibility. 

THERAPEUTIC HINTS.— These must be suggested by referring 
to the causes. 

Excessive mental efforts require principally: Bellad., Calc. carb., 
Coccul., Cuprum, Ignat., Laches., Lycop., Natr. carb., Natr. mur., 
Nux vom., Psorin., Pulsat, Sabina, Sepia, Silic, Sulphur. 

Emotional excitement suggests: Anac, Aurum, Bellad., Br} r on., 
Caustic, Chamom., Coccul., Coloc, Cuprum, Gelsem., Hyosc, 
Ignat., Laches., Lycop., Nitr. ac, Nux vom., Phosphor., Phosph. 
ac, Psorin., Pulsat., Staphis., Stramon., Veratr. 



800 SPINE. 

Sexual excesses : Compare the corresponding chapters. 
Exhausting diseases hint to: Calc. carb., China, Kali phosph., 
Pier, ac., Phosphor., Phosph. ac, Sulphur, etc. 

Hydrorrhachis Congenita; Spina Bifida. 

This is an affection entirely analogous to congenital hydro- 
cephalus. Being an imperfect development of the foetus, the 
latter is frequently expelled before its full time. There are cases, 
however, in which children are born with this affection at full 
time. Its nature, like hydrocephalus congenitus, is that of a 
dropsical effusion of serum, either between the dura mater and 
the vertebrae, or into the subarachnoideal space, or within the 
central canal of the spinal marrow. 

When such effusion takes place, before the vertebra? have per- 
fectly closed, its pressure from within prevents their final closing; 
thus, from deficiency of the vertebral arches, the spinal column, 
posteriorly, appears cleft in two; hence the name, "spina bifida." 
This cleft may be of different degrees. There may be only one 
of the vertebra? not closed. In the worst cases, this anomaly ex- 
tends over the whole spinal column. In most cases, however, 
the split is confined to the lumbar or sacral region. Through 
this opening the fluid which collects inside presses out, and ap- 
pears in the corresponding region as a smaller or larger tumor, 
according to the size of the opening and according to the quan- 
tity of fluid contained therein. In almost all cases this tumor 
grows rapidly after birth; it fluctuates; becomes denser and 
larger when the child cries, inhales, or presses at stool, or when 
it is held in an upright position ; it sinks in, becomes smaller, 
when the child is quiet, lies in a horizontal position, or when it 
exhales. External pressure upon the tumor is painful to the 
child, often causes convulsions and, if combined with hydroce- 
phalus, sopor and general paralytic symptoms. But these signs 
may all be wanting, when its communication with the spinal 
canal is very narrow. In some cases it is not fluid alone that 
protrudes through the opening of the vertebra?, but also portions 
of the spinal marrow itself, with its membranes and nerves. Such 
tumors are less fluctuating than those which consist of mere serum. 

In some cases the tumor or sac bursts during the birth of the 
child ; in other cases, as already stated, the tumor grows rapidly 
after birth ; the integuments gradually inflame, become exeori- 



LEPTOMENINGITIS SPINALIS. 801 

ated, and filially burst in a large circumference, which is fol- 
lowed by convulsions and death. In still others, only small 
openings form, and the fluid gradually oozes out of it ; it may 
close and reopen again ; most generally such cases terminate in 
death. Still there are cases on record in which individuals af- 
fected with spina bifida have lived to the age of puberty, and 
longer. 

THERAPEUTIC HINTS.— As the most important remedies, com- 
pare Arsen., Calc. carb., Calc. phosph., Lycop., Silic, Sulphur. 

Leptomeningitis Spinalis. 

We understand by this an inflammation of the soft membranes, 
the spinal pia mater and arachnoid; inflammation of the dura 
mater is rarely met with as a primary disease. 

Its Pathological Character. The pia mater appears pale 
reddish, sometimes purple, swollen, and infiltrated with a jelly- 
like and frequently bloody exudation. After a while the redness 
disappears and the membrane looks dirty, yellowish and grayish, 
being covered with a coagulated, dirty-grayish and yellowish ex- 
udation, resembling inspissated pus. The inflammation some- 
times extends over the whole membrane; reaching even into the 
cavity of the skull. In cases of recovery there are adhesions and 
thickening of the membrane, hypersemia, hydrorrhachis and atro- 
phy of the spinal marrow. The arachnoid is almost regularly 
involved in the inflammatory process. 

As Causes, we find mentioned, inflammatory processes of neigh- 
boring organs, either of the spinal marrow or of the vertebra?; ex- 
ternal injuries; exposure to cold, etc. It is quite a regular at- 
tendant upon Tubercular basilar meningitis. 

Remarkable is its epidemic appearance when it is usually 
combined' with cerebral meningitis, as in spotted fever, which 
compare. 

Symptoms. — A combination with cerebral affections of course 
tinctures the whole picture at once with brain symptoms, and 
may even disguise the spinal affection altogether. (See Brain 
Diseases.) If the inflammation is confined to the spinal pia 
mater, we find : 

1. A pain in the bach, at the place of inflammation, which even 
extends over the whole spine, and which is aggravated by the 

51 



802 SPINE. 

slightest motion, as turning in bed or rising, or pressing at stool, 
or voiding urine ; it is better during rest ; least in lying on the 
back ; sometimes it is combined with a feeling of constriction 
around the body, as though a bandage were fastened around it. 

2. Pains in the limbs, aggravated by motion and touch. 

3. Painful stiffness of the muscles, which may amount to opistho- 
tonus, especially in cases where the inflammation extends over 
the cervical portion of the pia mater. Even the masseter muscles 
may be affected, so that the whole resembles tetanus. Eespiration 
is difficult, and the higher the inflammation extends the greater 
is the dyspnoea, which may end in suffocation. It is a charac- 
teristic feature that these tonic spasms are always excited by the 
least motion of the spine, but not by reflex irritation of the peri- 
pheric nerves. 

Acute spinal meningitis may pass over into the chronic form, 
with exudation and consequent paraplegia. Tubercularization of 
the exudate is followed by oedema of the lungs, catarrh of the 
bladder and decubitus. Its Prognosis is therefore rather a 
doubtful one. 

THERAPEUTIC HINTS.— Aeon., after a sudden check of perspira- 
tion or an internal injury; high fever: crawling in the spine, as 
of beetles; cutting pain, extending in a circle from the spine to 
the abdomen; numbness of the small of the back, extending into 
the lower limbs; the arms hang down powerless, as if paralyzed 
by blows; numbness, icy coldness and insensibility of hands and 
feet; all being accompanied by despairing thoughts and dread 
of death. 

Atrop. sulph., convulsions all over, if Bellad. did not prevent. 

Bellad., drawing, burning and throbbing pain in the spine; 
drowsiness, with inability to sleep; frequent starting, as if electric 
shocks were running through the limbs. 

Bryon., stitch-like pains from the slightest motion. 

Calc. carb. and phosph., when the inflammation proceeds from a 
disease of the bony structure of the spine. 

Cicuta, frequent jerks in the upper portion of the body: through 
the dorsal vertebra? and arms; occasional jerkings of the head. 

Coccul, unwieldiness of the lower extremities, the legs cannot 
be lifted in walking, but are dragged along; the hands feel pithy, 
lose their sensibility. 

Cuprum, clonic spasms, commencing in the fingers and toe? and 



MYELITIS. 803 

spreading further; before the spasms, painful jerkings in the 
hands and fingers and different parts of the body, commencing 
on the left side. 

Dulcam., rheumatic persons, who are always worse when the 
weather changes to cold; after taking cold ; also during scarlatina 
and measles, when the eruption does not fully develop itself. 

Hyper., after a fall ; slightest motion of the arms or of the neck 
extorts cries ; the cervical vertebras are very sensitive to touch ; 
headache ; desire for warm drinks ; asthmatic spells, or spells of 
short, hacking cough. 

Kali hydr., after the abuse of mercury. 

Mercur., paralysis of the lower extremities, of the bladder, or of 
the rectum, with occasional jerks in the paralyzed parts ; violent 
pain in the spine, worse from motion ; great restlessness and 
sleeplessness ; aggravation at night in bed ; insensibility of the 
skin. 

Nux vom., the seat of the pain is the lumbar region ; the pain 
is worse when trying to move whilst lying on the back, also worse 
in the morning; stiffness of lower limbs; great deal of belching; 
sensitiveness of the stomach and region of the liver to external 
pressure ; stool seldom and hard. 

Plumbum, in chronic cases, where the paralyzed parts soon fall 
away in flesh, where the limbs become painfully contracted, and 
where there are frequent spells of colic with retraction of the ab- 
domen ; worse on right side. 

Rhus tox., in combination with exanthematic processes ; or in 
consequence of getting wet ; high fever ; great restlessness ; tin- 
gling sensation in the limbs ; paralysis of the extremities. 

Myelitis, Inflammation of the Spinal Marrow. 

This affection is much less frequent than meningitis ; and 
when it does occur, it almost always is associated with meningitis. 

Its pathological features in the stage of hyper semia (red soften- 
ing) consist of swelling, redness, and exudation ; in the stage of 
fatty degeneration arid of resorption (yellow and white softening) 
the affected substance assumes a creamy or milky appearance, 
becomes softer and softer, until at last nothing remains but the 
vascular network, and a portion of the hypertrophied septa, the 
softened nerve-substance having been gradually absorbed. This 
leads in the terminal stage to the formation of cicatrices or cysts, 



804 SPINE. 

induration and sclerosis or hardening. The meninges are always 
more or less implicated in the inflammatory process. 

Its localization in the spinal cord varies greatly. "When acute 
it. usually commences in the graj 7 substance and may extend 
more or less in a vertical direction — (Myelitis centralis); it may 
pervade the entire thickness of the cord for a longer or shorter 
distance— (Myelitis transversa); it may involve only a small por- 
tion of the cord — both vertically or transversely — (Myelitis circum- 
scripta) ; it may be spread over a large area but only in circum- 
scribed and scattered spots — (Myelitis disseminata); it may attack 
only the peripheral layers of the cord — (Myelitis peripherica). 

As its Causes are mentioned, chiefly, external injuries, and 
exposure to cold, or extension of inflammatory processes from 
neighboring parts. Sometimes it has been observed during the 
course of typhus, of the acute exanthemata, acute rheumatism, 
variola, pleuro-pneumonia, and other severe illnesses. 

Its Symptoms embrace deviations in sensibility and motion. 

1. Sensibility. The patient experiences at first a sensation of 
coldness, numbness, prickling and pain in single toes and fingers, 
which sensation extends from the periphery gradually further up 
towards the body; at first, perhaps, only in one, but soon in both 
sides. If there be a complication with meningitis, the patient 
cannot bear the slightest pressure or motion of the parts. 

There is a pain in the spine, where the inflammation exists, 
which is aggravated more by external pressure than by motion ; 
and a feeling of constriction in those parts of the body which are 
supplied with those nerves, the roots of which originate in and 
near the affected part of the spinal marrow (girdle pain). In 
some cases these parts are very sensitive, whilst those below are 
quite dull and insensible. A complete anaesthesia or insensibility, 
however, takes place only in those cases in which the lesion is a 
degeneration of the marrow through its whole diameter. 

2. Motion, It shows itself at first as an unwieldiness of the 
peripheric muscles, which may end in complete paralysis. If the 
seat of the lesion be in the lumbar region, it causes paralytic 
symptoms of the lower extremities, which is of the most frequent 
occurrence; if it be in the dorsal region, it causes, in addition, 
paralysis of the sphincter ani and vesicae : and if still higher up, 
violent agitation of the heart, A lesion in the cervical region 
affects the upper extremities, the respiratory motion, deglutition 
and even speech. Respiration is most seriously interfered with 



MYELITIS. 805 

when the lesion exists just above the origin of nerves of the dia- 
phragm. When below it, it is a characteristic symptom that the 
patient is able to gape, but he cannot cough or sneeze. 

As long as the marrow is not disorganized in its whole diameter, 
so long is it possible that the parts below the lesion may still re- 
main intact; so that, for example, in a cervical myelitis only the 
upper extremities are paralyzed and the lower not. When, how- 
ever, the lesion extends through the entire diameter of the mar- 
row, then all the parts below the lesion lose sensibility and mo- 
tion ; so that in such a case the patient consists of two halves : 
an upper one, which is normal and sound, and a lower one, which 
is dead, and deprived of feeling and voluntary motion. 

A peculiar and frequent symptom of myelitis is a persistent 
erection of the penis. The penis is painfully stiff, but shorter than 
normal, and may remain so for days. It occurs chiefly in those 
cases in which the lesion has its seat in the dorsal or cervical 
region. 

Thus far Ave have seen that the symptoms of myelitis vary 
quite considerably according to the higher or lower location of 
the lesion. They vary, likewise, if the seat of the inflammation 
is confined only to the one or the other lateral cord. In such 
cases the paralytic symptoms may be only on one side — at least 
for a while — with more or less insensibility; or insensibility may 
exist in one, and paralysis in the other side, as in some traumatic 
cases. 

The lower the seat of the disease, the more slowly it works. 
Many have lived more than ten years with paraplegia. Cervi- 
cal inflammation may terminate fatally in a very short time by 
its paralyzing effect upon respiration. 

THERAPEUTIC HINTS.— As myelitis is almost always accom- 
panied by meningitis, compare Leptomeningitis. 

Angustura vera, twitching and jerking along the back like elec- 
tric shocks; tension of facial muscles; lockjaw. 

Arsen., dyspnoea and anxiety; constriction and tightness of 
chest, as if bound with a hoop ; twitching, trembling, violent 
starting, weariness in all limbs ; tetanic spasms. 

Gelsem., early stage ; spinal weakness from exhaustion ; confu- 
sion of head, spreading from occiput to forehead ; dim sight ; 
looks heavy, dull, drowsy; paresis of tongue and glottis; incon- 
tinence of urine ; muscles feel bruised and will not obey the will ; 
loss of voluntary motion. 



806 SPINE. 

Mercur., probably the most important. Compare Meningitis. 

Phosphor., after sexual excesses or getting wet; also when in 
connection with an inflammatory process of the vertebrse ; burn- 
ing pain in the spine; some vertebrse sore to touch; dyspnoea 
and cough ; weakness of sight ; transient vertigo ; constipation, 
with narrow, dry stools ; numbness and insensibility of the ex- 
tremities. 

Physostigma, tremors of young persons from emotional or phy- 
sical disturbances; staggering gait, as if drunk; feeling of con- 
striction around head and waist; feeling of weakness, as though 
paralyzed, passes downward from occiput through back to lower 
limbs, which feel as if asleep. 

Picric ac, tonic and clonic spasms; keeps legs wide apart when 
standing; looks steadily at objects, as if unable to make them 
out ; limbs too weak to support the body. 

Secale, violent pain in the back, especially in the sacral region ; 
anaesthesia of the limbs; paralysis of the limbs; convulsive jerks 
and shocks in the paralyzed limbs; painful contraction of the 
flexor muscles ; paralysis of the bladder and rectum. 

Silic, when the bony structure of the spine is affected. 

Sulphur, burning and tensive aching between the scapula?; heat 
on the top of the head; palpitation of -the heart; sleeplessness; 
often when other remedies do not seem to have any effect. 

Veratr., painful paralytic weakness in the upper and lower 
limbs : he is scarcely able to drag them ; tingling in the fingers, 
causing anxiety ; painful jerkings in limbs. 

Myelomalacia, Non-inflammatory Softening of the 
Spinal Marrow, 

Is a process of which we know scarcely anything. Its symptoms 
are quite obscure, sometimes covered by the symptoms of spinal 
apoplexy, or myelitis, or typhus, sometimes even wanting. Its 
pathological character is a non-inflammatory degeneration of the 
marrow, by which it becomes converted into a soft, macerated 
mass of a whitish, yellowish or reddish color. 

Inflammatory softening is the consequence of acute myelitis. 

Multiple Sclerosis 

"Is a form of chronic myelitis and encephalitis, which is char- 
acterized, anatomically, by the development of numerous insulated 



MULTIPLE SCLEROSIS. 807 

sclerotic nodules, varying in size and of a chronic inflammatory 
nature, which are scattered irregularly throughout the entire 
cord, and usually also throughout the entire brain, but which 
seem to possess, nevertheless, certain spots of predelection. Some- 
times a less intense, but more diffuse sclerosis unites the different 
nodules with one another." (Erb). It attacks women oftener 
than men and most frequently makes its appearance during the 
second and third decades of life, scarcely ever after the forty-fifth 
year, and but few cases are known to have occurred in children 
under ten years of age. 

As direct Causes are mentioned : catching cold, excessive men- 
tal and bodily exertions and intense emotions, traumatic influen- 
ces, pregnancy, hysteria and acute diseases. 

Its Symptoms are extremely variable and manifold, as a natu- 
ral result of the development of nodules in so many different 
localities. 

Disturbances of sensibility are of not constant occurrence; dis- 
turbances of co-ordination (ataxia) are frequently observed, but a 
peculiar tremor, which accompanies voluntary movements and 
progressively increases, is almost regularly present. By this tre- 
mor, which appears at every attempt at moving a part of the body, 
head or limb, voluntarily, differs multiple sclerosis entirely from 
paralysis agitans, where the trembling is predominantly observed 
during perfect rest, and may, at least in the earlier stages, be even 
controlled by the will of the patient. 

Besides these symptoms we observe: alteration of speech and 
voice. The speech is slow, hesitating, more or less indistinct and 
the voice becomes weak and monotonous; the acts of laughing 
and crying are accompanied by peculiar, noisy inspirations, and 
the movements of tongue and lips are frequently impaired, inter 
fering with mastication and deglutition. There is temporary or 
permanent diplopia, also nystagmus, amblyopia and at last blindness 
from atrophy of the optic nerve. We meet also head-symptoms in 
the form of vertigo, sleeplessness, violent headaches and in some cases 
repeated apoplectiform attacks, which are accompanied by high 
fever and followed by temporary hemiplegia. 

This complex of symptoms fits only to typical cases; variations 
are exceedingly numerous, because the accidental distribution of 
the nodules varies in each individual case. 

THERAPEUTIC HINTS.— Compare Myelitis. 



Arg. nitr., vertigo and staggering gait; trembling and tremu- 
lous sensation; general debility with trembling of the limbs; 
ehorea-like movements of limbs; transient blindness; sunken, 
pale countenance; sleeplessness. 

Nux vom., especially in the beginning, with gastralgic attacks, 
vertigo, etc. 

Phosphor., weakness of extremities and trembling at making an 
effort; legs weak, gait tottering as if he were not sure of himself! 
speech embarrassed; amaurosis with widely dilated pupils and 
deafness. 

Physostigma, the will is strong, but a difficulty lies in the way of 
carrying out its purpose; the palsy is commonly preceded by 
twitching or trembling of the muscles. Attacks of partial blind- 
ness; nystagmus; trembling all over. 

Plumbum, tremor of right arm .during voluntary motion; the 
arms are "shaky" when he attempts to use them; tremor of 
arms, at times preceded by weakness and numbness; the tongue 
trembles when being protruded, or when he tries to articulate; 
speech dragging and slow. Diplopia; dimness of sight; neuritis 
of optic nerve. There are many more symptoms which hint to 
multiple sclerosis. 

Tarant. 12 , in water. Multiple sclerosis in consequence of fright 
and rheumatism. Trembling commenced in left hand, always 
aggravated by mental trouble. After a fright it affected all 
limbs. Intense pain during night prevents her rest and sleep, 
and an itching and crawling of left leg makes her rise and walk 
about. Bathing increases the pain, but fresh air ameliorates 
even at night. Intelligence and memory considerably dimin- 
ished; trembling and pricking prevents from doing any fine 
work. Motility and sensibility unaltered; neither paralysis, 
anaesthesia, nor hypersesthesia. The head' trembles as much as 
the left hand and foot, and a slight tremor could be observed on 
the tongue, when opening the mouth. Xo appetite, chronic con- 
stipation. Since menopause, acne in face. The ophthalmoscope 
showed a slight hyperemia of the retina. (Cramoisy.) 



TABES DORSALIS. 809 

Tabes Dorsalis; Sclerosis of the Posterior Columns; Gray 

Degeneration of the Posterior Columns; Progressive 

Locomotor Ataxy; Leukomyelitis Posterior 

Chronica. 

All these different names have been given to "a disease of the 
spinal cord which runs a slow course, which arises principally 
during youth and middle age, and which in all probability be- 
longs to the group of Chronic myelitis." (Erb.) 

" It is anatomically characterized by ribbon-like sclerosis of the 
white posterior columns, leading to gray degeneration, and prob- 
ably, also, by later participation on the part of the adjoining 
portions, of the white lateral columns and the gray posterior 
horns." "The affection generally begins in the lumbar region, 
and may extend throughout the entire cord as far as the upper 
cervical portion, and even into the medulla oblongata." (Erb.) 

It attacks men much oftener than women, in the majority of 
cases between the thirtieth and fiftieth year of life; before the 
twentieth and after the fiftieth year the disease is of rare occur- 
rence. 

Its principal Causes are said to be: sexual excesses and onan- 
ism, catching cold, bodily overexertions and hardships of all 
kinds, traumatic injuries, emotional fits and passions; acute dis- 
eases, such as typhus, rheumatism, pneumonia, abortions, loss of 
blood, long-continued lactation, etc., diphtheria, etc. In many 
cases not any cause can be detected. 

Its Symptoms of the first stage consist of lancinating, neuralgic 
pains in the lower limbs, sometimes including the trunk, and 
more rarely the arms, in parox}^sms, frequently changing in se- 
verity and location, and often extending over many months or 
even years; they at first appear at intervals, in the spring and 
fall, later they are induced by every change of weather, or any 
overexertion or mental disturbance. With these pains become 
associated, sooner or later, various kinds of paresthesia, such as 
numbness, pithiness or formication in the feet, legs, thighs and 
on the trunk, and in the ulnar domain of one or the other hand 
— a characteristic symptom — in other cases, the sensation of a 
tight girdle at various heights on the trunk, or on the knee-joint 
or ankle-joint; further motor weakness and insecurity, which grad- 
ually increases to real motor disturbances, such as inability to 
walk and stand with former ease; unsteadiness when standing 



810 SPINE. 

and walking; a swaying to and fro when on the feet, all of which 
manifestations are more pronounced in the dark or by closed 
eyes. Often, not in all cases, to these disturbances are added, 
diplopia in consequence of paresis or paralysis of various eye- 
muscles, especially those supplied by the oculomotorius, and 
amblyopia, even amaurosis, in consequence of degeneration of the 
optic nerve. In many cases we meet with disturbances of the 
bladder,. such as difficulty of micturition, dribbling of urine, etc., 
and with weakness and irritability of the sexual functions, such as 
various grades of impotence, insufficient erections, premature 
ejaculations, nocturnal or diurnal pollutions, excitability on com- 
ing in contact with women, etc. Gastralgia and head symptoms 
(dizziness, psychical irritability, etc.) are of rarer occurrence. 

The second stage presents, besides the symptoms just detailed, 
a characteristic disturbance in the coordination of motion, which 
usually commences in the lower limbs. The gait becomes ataxic, 
that is, insecure, swaying, staggering; the legs are unsteadily 
swung about, the toes pointing outward and upward, and the 
heels coming down to the ground with a stamp ; the whole oper- 
ation, in most patients, is done under close supervision of the 
eyes, and does not succeed at all with closed eyes or in the dark. 
With this faultily and imperfectly controlled movement of the 
limbs goes hand in hand a diminution of their powers of endur- 
ance, and, although in a lying position at first, the gross strength 
of the legs seems but little reduced, — the patient is yet able to exe- 
cute single movements of the limbs with tolerable certainty and 
strength, while in a lying position — yet by and by even in this 
position the voluntary motions become more and more uncertain, 
and especiall}' so, if the patient closes his eyes, while at last walk- 
ing and standing become quite impossible without help. 

As the disease advances, the ataxy extends also to the arms and 
hands, so that complicated movements, such as writing, piano- 
playing, sewing, etc., become difficult, awkward, and at last im- 
possible; the muscles do not obey any more the command of the 
will, but make all sorts of jerking and irregular movements when 
under its stimulation. The reflex action of the tendons is extin- 
guished ; a knock or blow, for instance, upon the patella-tendon 
above the knee is not followed any more by a jerk of the leg up- 
ward, etc.; the reflex action of the skin, however, may or may 
not be affected. All other symptoms of the first stage grow more 
and more intense, until at the final stage actual paralysis (para- 



TABES DORSALIS. 811 

plegia), muscular atrophy, contractures, troubles of the bladder 
and the digestive organs, bed-sores and general marasmus finish 
the scene. 

The disease is of long duration, which is to be counted by years, 
and is characterized by considerable fluctuations for better or 
worse — sometimes gradually advancing to recovery ; oftener, 
however, terminating in death. ■ 

It differs from Chronic myelitis by its lancinating pains in the 
first stage and pronounced ataxy in its second stage, which mye- 
litis has not; 

From Multiple sclerosis by the same, instead of which multiple 
sclerosis presents a characteristic tremor on voluntary movement, 
attacking limbs as well as head, and neck ; 

From Progressive cerebral paralysis by the absence of disturb- 
ances of speech and psychical changes, which are characteristic 
of cerebral paralysis ; 

From Paralysis agitans by its disturbance in the co-ordination 
of motion, instead of which there is in paralysis agitans a tremor 
in perfect rest. 

THERAPEUTIC HINTS.— Alcohol, tremor worse in morning, can- 
not write ; increasing muscular debility and paralysis ; tingling, 
arthralgia, anaesthesia, clonic and epileptiform convulsions; loco- 
motor ataxy. 

Alum, met, recommended by Yon Bcenninghausen and verified 
by others. Soles of feet feel as if they were swollen and too soft ; 
numbness of the heels ; heaviness of limbs, can scarcely lift them : 
slow, staggering gait, as after a long sickness ; inability to walk 
except with eyes open and in daytime; pain in back as if bruised, 
or as if a hot iron were thrust through the lower vertebrae. 

Arg. nitr., pains in the back, cannot walk with eyes closed, or 
in the dark ; paralytic heaviness or weakness of the legs : stag- 
gering gait ; legs feel as if made of wood, or padded, with insen- 
sibility to touch, diminished warmth, jerks in the toes, tottering, 
irresolute gait; emaciation of legs, with paralytic weakness; 
chorea-like convulsive motion of limbs ; legs drawn up : arms 
jerked outward and upward. 

Arsen., distressing pains ; deadness in great toes, extending to 
foot and ankle-joint; feet feel large and heavy, and can be moved 
only by moving the whole limb ; the gait is shuffling ; feet are 
dragged along by lifting the legs; slight numbness in hands. 



812 SPINE. 

Paralysis with gressus gallinaceus, with atrophy of the muscles 
especially of lower extremities. 

Bellad., heaviness and lameness of legs and feet ; he raises the 
feet slowly and puts them down with force; loss of co-ordination 
of musdes of both upper and lower limbs; trembling, twitching 
of limbs. Diplopia; amauros's. 

Calc. carb., rheumatic pains in shoulders; loss of muscular 
power; atrophy of muscles of back, buttocks and lower limbs, 
with constant quivering; dimness of vision worse in right eye; 
cramps in feet and legs ; excessively nervous ; no appetite ; con- 
stipation. (G. F. Butman.) 

Cupr. ac, numbness and lameness of left hand, especially of the 
fingers as far as they are supplied with the nervus ulnaris. 
Dragging of left foot in walking ; numbness and lameness in 
sole of left foot gradually extending up to knee; walking and 
standing difficult ; foot and leg atrophied ; constant sense of 
coldness in left foot, little relieved by the application of hot 
bricks. Sometimes dull pain from hip to knee. (Heinigke.) 

Gelsem., acute, sudden, darting pains; shooting, tearing along 
the tracks of the nerves, aggravated by changes of the weather: 
paralysis of motion; muscles will not obey the will, feel bruised; 
tingling, prickling, crawling. 

Nux vom., partial paralysis of lower limbs from overexertion 
and being drenched in rain; drags limbs in walking, cannot lift 
them from the ground ; sensation of lower limbs impaired, feels 
the sticking with a pin only when it penetrates deep enough to 
draw blood; legs always cold, bluish; constipation; burning at 
aims; occipital headache; no painful spot in the whole length of 
spine. (Bojanus.) 

Phosphor., burning heat in back; hands and feet numb, clumsy: 
limbs tremble from every exertion; when walking makes mis- 
steps, from weakness; swelling of hands and feet, with stinging 
pains; paralysis, formication and tearing in the limbs; anaesthe- 
sia; increased heat; sexual irritation; nocturnal emissions: great 
irritability and nervousness. 

Physostigma, unsteady from knees downward on walking, he 
must look to see where he puts his feet; needs a cane to steady 
himself. 

Picric ac, mental and physical prostration; cannot read a line 
without becoming exhausted: on attempting to walk he presses 
his hand upon his loin and slides his feet along the ground as in 



SPASMODIC SPINAL PARALYSIS. 813 

a paretic condition, soon becoming exhausted; dull headache 
deep in occiput; bodily exhaustion with mental clearness; sleep- 
lessness at night from sheer exhaustion; when asleep priapism 
and seminal emissions, with or without sexual dreams; during 
coition ejaculation too quickly; constipation. (S. Lilienthal.) 

Secale, difficult, staggering gait; complete inability to walk, not 
for want of power, but on account of a peculiar unfitness to per- 
form light movements with the limbs and hands; contraction of 
the lower limbs, on account of which the patient staggers; trem- 
bling of the limbs, sometimes attended with pains; formication of 
hands and feet. Excessive sensation of heat, with aversion to 
heat or of being covered. (S. Lilienthal.) 

Stramon., totters as if giddy, cannot make a few steps without 
help; trembling of limbs; muscles will not obey the will; diffi- 
cult to bring hand to tumbler or carry the latter to mouth; 
obscuration of vision. 

Sulphur, unsteady gait; great debility and trembling; limbs go 
to sleep. After Nux vom. (Jahr.) 

Tarant, difficulty of moving the legs, they do not obey the will; 
weakness of legs, etc. 

Aside of these compare: iEscul. hipp., Coccul., Caustic, Laches., 
Nux mosch., Pinus sylv., Plumbum, Rhus tox., Silic. and many 
more. 



Spasmodic Spinal Paralysis. 

"This disease is clinically characterized by a gradually increas- 
ing paresis and paralysis, generally advancing slowly from below 
upwards, with muscular tension, reflex contractions and contractures, 
with strikingly increased reflex actions of tendons, while at the same 
time there is entire, or almost entire, absence of all disturbances of 
sensibility or trophic disturbances, of all vesical or sexual weakness, 
and of all cerebral disturbances." (Erb.) 

Its anatomical basis is probably, according to Charcot and Erb, 
a chronic inflammatory process, a sclerosis of the posterior divisions of 
the lateral columns. 

Its Etiology is unknown ; it seems to develop most frequently 
between the ages of thirty and fifty, and also at times in earliest 
childhood. 

Its Symptoms begin with motor weakness in one or both lower 
limbs, increasing to paresis and ending in paralysis. These symp- 



814 SPINE. 

toms of weakness are early associated with motor irritations, com- 
mencing with twitchings, or jerkings of the legs when sitting or 
lying, increasing to spasmodic stiffness when making certain 
movements, or to regular tension of the muscles on active and still 
more on passive motion, and ending in permanent and severe 
contractures, which fix the limbs in a position of extension. With 
all this there is a marked increase of the reflex action of the tendons, 
so that on merely placing the point of the foot on the floor, while 
sitting, a tremor very generally sets in, evidently in no respect 
different from the clonic trembling on passive dorsal flexion of 
the foot. 

These combined paralytic and spasmodic manifestations result 
in a very peculiar, the so-called spastic gait, when the patient tries 
to walk, which is described by Erb as follows: "The legs are 
somewhat dragged, the feet seem to cleave to the ground, the tips 
of the feet find an obstacle in every inequality of the ground; 
every step is accompanied by a peculiar hopping elevation of the 
whole body, dependent on a reflex contraction of the calf; the 
patient immediately gets upon his toes, and slips forward on 
them, showing a tendency to fall forward. The legs are close 
together, held stiffly, the knees somewhat depressed forward, the 
upper part of the body slightly bent forward. There is no 
throwing about of the feet as in ataxy. This gait depends on 
muscular tension and reflex contractions in the various groups of 
muscles, which are set in activity during the process of walking." 

Sometimes the disease extends from one leg to the arm of the 
same side [hemiplegic form), and much later to the other leg and 
arm. In some cases the trouble begins in one or both arms and 
gradually descends to the legs. 

This whole group of symptoms becomes quite conspicuous by 
the absence of every disturbance of sensibility, of vesical and sexual 
weakness, of muscular atrophy and bed-sores; of disturbances of tJic 
brain and cranial nerves, and is thus easily distinguishable from 
other spinal and cerebral affections already detailed. 

Its course is slow and of long duration, and most generally ter- 
minates fatally by some other intercurrent disease. 

THERAPEUTIC HINTS.— There is no case on record, as far as I 
am aware of, which has been diagnosed and treated as this par- 
ticular form of disease. The special hints must be taken from 
special and peculiar symptoms of the individual case. 



POLIOMYELITIS ANTERIOR ACUTA. 815 

Poliomyelitis Anterior Acuta, Acute Inflammation of the 
Gray Anterior Columns (Anterior Horns). 

This affection has also been called : Spinal infantile paralysis, 
acute spinal paralysis of adults, acute atropine spinal paralysis, pa- 
ralytic atrophique de I'Enfance, and is marked by the following- 
group of characteristic symptoms: "It begins suddenly, usually 
with fever, with severe cerebral symptoms (deafness, coma, de- 
lirium, general convulsions); there is very rapidly developed and 
complete paralysis with entire relaxation of the muscles, this pa- 
ralysis being of very variable distribution over the trunk and 
extremities, but generally in the form of paraplegia ; there is an 
absence of any severe disturbances of sensation ; no paralysis of 
the sphincters, nor bed-sores. 

A rapid improvement of the general condition soon follows; 
the paralysis proves not to be of a progressive character ; indeed, 
gradual improvement of the same begins, although the restitu- 
tion of movement is not uniform and remains in part lost forever. 
In some of the muscles there is extreme and rapidly progressing 
atrophy, with degeneration of tissue ; the development of the 
bones is retarded ; the extremities are cold and cyanotic. Dur- 
ing the further course of the affection considerable deformities of 
the limbs and trunk arise (club-foot, curvatures of the spine, pa- 
ralytic contractures, etc.). The general condition of the individ- 
ual is admirable, in spite of the permanent defects in the motor 
apparatus, which almost invariably remain. 

The disease may occur at all periods of life, though it is by far 
the most frequent in children between the ages of one and four 
years. It is susceptible of an unusually large number of grades 
of severity. 

The anatomical lesion, although not yet quite certainty deter- 
mined for all cases, may be regarded as most probably consisting 
in an acute myelitis of the gray anterior columns (anterior horns), 
which may extend more or less over the greater part of their 
entire length, but is disposed to be most heavily localized in the 
cervical and lumbar enlargements." (Erb.) 

Of its Etiology nothing is known with certainty. 

THERAPEUTIC HINTS.— The initial symptoms may require: 
Aeon., Bellad., Gelsem., etc. 

Compare Myelitis and Leptomeningitis. 



816 SPINE. 

Polyomyelitis Anterior Subacuta et Chronica; Subacute 

and Chronic Inflammation of the Gray Anterior 

Horns; Chronic Atrophic Spinal Paralysis. 

"Clinically the disease presents itself as a motor paralysis, 
usually developed without fever, with but slight general disturb- 
ance and insignificant disturbances of sensibility. The paralysis 
more or less rapidly seizes the entire lower extremities — generally 
in the course of a few days, or at the most a few weeks— and 
soon extends to the upper extremities also (much more rarely 
showing the opposite order of development and beginning in the 
upper extremities); it is associated with complete flaccid it y of the 
muscles and loss of their reflex excitability, and is followed by rapidly 
progressive atrophy in the bulk of the paralyzed muscles, with the 
well-marked reaction of degeneration. 

The disease has certainly, as a rule, an ascending course, 
though it is by no means always progressive; its development 
generally comes to a standstill sooner or later, this arrest intro- 
ducing a gradual retrogression of the disturbances, which may 
lead to more or less complete recovery. 

The anatomical limits of the disease cannot, as yet, be declared 
with absolute certainty; but according to all that we know, there 
is every probability of its being located in the gray anterior 
horns. The two post-mortem examinations thus far made vir- 
tually confirm this, and thus, for the present, we may designate 
the disease as a subacute or chronic inflammation or degeneration of 
the gray anterior horns, with extensive disappearance and atrophy 
of the large multipolar ganglion-cells." (Erb.) 

Etiology unknown. Duration long. 

THERAPEUTIC HINTS.— Plumbum. The symptoms of chronic 
lead-poisoning correspond very closely with the symptoms of this 
complaint. 

Paralysis Ascendens Acuta, Acute Ascending Paralysis. 

"The disease is clinically characterized by a motor paralysis, 
which generally begins in the lower extremities, spreads pretty 
rapidly over the trunk to the upper extremities and usually also 
involves the medulla oblongata, which sometimes runs its course 
without fever, sometimes with more or less active fever, which 



COCCYODYNIA. 817 

but slightly involves the general sensibility and the functions of 
the bladder and rectum, and which runs its course without any 
notable atrophy of the muscles, and without any diminution or 
change of their electrical excitability. 

In the majority of instances the disease terminates fatally by 
asphyxia, paralysis of deglutition, and the like; but lighter cases 
may also end in recovery. 

The anatomical characteristics of the disease are at present 
purely negative. No pathologico-anatomical alterations are to 
be found anywhere, and especially not in the spinal cord, which 
might explain the picture of the disease. In particular there are 
no signs of hyperaemia within the spinal cord, of myelitis, of 
acute destruction of the ganglion-cells or nerve-fibres. 

If the disease is therefore to be localized within the spinal cord 
at all, it is a question of finer, so-called impalpable, disturbances 
of nutrition, not accessible to our present means of examina- 
tion." (Erb.) 

Of its Etiology nothing positive is known. Most cases occur 
between the ages of twenty and forty, some later; men are most 
frequently attacked. 

THERAPEUTIC HINTS.— Consider all the remedies which show 
paralytic affections. Many cases may have been cured homceo- 
pathically without having been recognized as just this particular 
form of disease. 

Coccyodynia 

Signifies pains in the coccyx and coccygeal region (muscular and 
tendinous fibres of the parts attached to the coccyx), of great 
variety of character and especially felt on sitting down or rising 
up, or straining to defecate, or attempting to exercise, but even 
during perfect rest. It may be of a neuralgic or rheumatic, or 
inflammatory nature. It has been observed to originate from 
"catching cold," especially in clamp and cold weather; from falls 
and blows ; from riding on horseback ; after parturition and de- 
livery by forceps; after suppression of eruptions. It attacks most 
frequently the female sex, is often of but short duration, but may 
be a source of great annoyance for years. 



818 SPINE. 

THERAPEUTIC HINTS. — In injuries with crepitation: Calc. 



For periodical aching: Ruta grav., Rhus tox., Silic., Fluor, ac. 
(Hering.) 

After a fall on the ice; pain worse after sleep: Laches. (Raue.) 

During the first appearance of catamenia after confinement : 
Cicuta. (Bruckner.) 

After confinement, burning and smarting and painful uneasi- 
ness in the coccyx, better when standing, worse from slightest 
motion or pressure. Tarant. (Gonzales.) 

W. S. Searle gives the following hints : 

Bellad., ischia feel sore, as if no flesh were on them, yet she feels 
better when sitting upon something hard ; intense crampy pain 
in small of back and coccyx ; can sit only a short time ; cannot lie 
down well ; wakes often at night, and has to shift her position ; 
unable to lie at all upon the back, and is most relieved by stand- 
ing or walking slowly. 

Caustic, dull, drawing pain in region of coccyx ; darting and 
bruised feeling in coccyx ; pain in small of back from any move- 
ment ; pinching, crampy pain in lumbar region and buttocks. 

Carb. an., pain in coccyx, which becomes a burning pain when 
the parts are touched ; pressing, bearing-down pain in coccyx, as 
if bruised ; pain as from subcutaneous ulceration, worse on sitting 
or lying down ; pressing, drawing, or stiffness in the lumbar re- 
gion, as if the back were broken. 

Thuja, painful drawing in sacrum and coccyx, and in the thighs 
when sitting; after having been seated a while, the drawing- 
hinders standing erect ; sudden cramp-like pain in lumbar re- 
gion after long standing, and then attempting to walk ; it seems 
as if he would fall. 

Caun. sat, pressure, as if with a sharp point, on the coccyx. 

Canthar., lancinations and tearings in the coccyx, causing him 
to start. 

Cicuta, tearing, jerking in coccyx. 

Cist, can., burning, bruised pain in coccyx. 

Drosera, itching stitch in coccyx when sitting. 

Graphit, dull drawing in coccyx in the evening: violent itching 
of coccygeal region, the part being moist with scurfy eruption. 

Kali carb., violent gnawing, at rest and in motion. 

Kali hydr., pain in coccyx as from a fall. 

Kreosot, drawing pains along the coccyx down to the rectum and 



COCCYODYNIA. 819 

vagina, where a spasmodic, contractive pain is felt ; better when 
rising from her seat ; subsequent milky leucorrhoea. 

Laches., continual pain in sacrum and coccyx ; drawing pain, 
or as if sprained, in small of back, hindering motion. 

Magnes., sudden, piercing pain in coccyx ; sudden, violent, con- 
cussive, tearing, stitching pain in this region as if the spine were 
bent back. 

Mercur., tearing pain in coccyx relieved by pressing the hand 
against the abdomen ; pain in sacrum, as if one had been lying 
on too hard a couch. 

Mur. ac, drawing, burning along the back, beginning at the 
coccyx, as if under the skin ; burning stitch in sacrum, causing 
one to start. 

Paris quad., tearing in coccyx when sitting ; pulsative stitches 
in coccyx. 

Petrol., pain in coccyx while sitting; great uneasiness and 
stiffness in small of back and coccyx in the evening. 

Phosphor., ulcerative pain, hindering motion, and followed by 
painful stiffness of nape of neck. 

Phosph. ac, itching stitch in coccyx ; fine stitches in coccyx and 
sternum. 

Platina, numb feeling in coccyx as from a blow. 

Ruta, pain from coccyx to sacrum, as if caused by a bruise. 

Zincum, pushing, aching, or at times, pinching pain in coccyx ; 
lancination in sacrum ; pressure, tension and weakness in lumbar 
and sacral region ; cracking in back when walking. 



MOTORY APPARATUS. 



Rheumatismus. 



We may, as characteristic of rheumatismus, establish the follow- 
ing three points : 1. It attacks either the fibrous tissues, joints, 
aponeurosis, the sheaths of the tendons, the neurilemma, the peri- 
osteum, or the muscles and tendons. 2. It is a peculiar, painful 
affection, caused no doubt by inflammation, nutritive disturb- 
ances; and, 3. It comes on independently of other acute and 
chronic diseases, or traumatic causes, etc. 

The principal Causes of its development are exposure to cold 
and atmospheric influences, though they may not be the only 
causes; and thus it is agreed among tbe profession to call rh< wmatic 
all those affections which are of a very painful and inflammatory 
nature, which have become localized in any of the above-stated 
tissues, and which are not of a secondary, or a sympathetic, or 
traumatic nature, but appear idiopathic; be they caused by ex- 
posure to cold and atmospheric influences or not. Its peculiar 
inclination to change localities is, although of frequent occur- 
rence, not an invariable feature of tbe disease. Rheumatismus 
has heen divided according to its location, into — 

1. Rheumatismus Articulorum Acutus, Acute Rheuma- 
tism of the Joints ; Polyarthritis Rheumatica 
Acuta. 

In this form its seat is the synovial membranes of one or several 
joints. By a nutritive disturbance they become inflamed, and 
yield a scanty exudation, which contains neither much fibrin nor 
a great many pus globules. The external visible swelling is the 
product of an inflammatory oedema of the surrounding cellular 



RHEUMATISMUS ARTICULORUM ACUTUS. 821 

tissue. In severe cases, however, the inflammation may be very 
high, and the exudation quite rich in fibrin or pus globules. 
Accordingly, post-mortem examinations show either scarcely any 
inflammatory signs or a high state of hyperemia, and ecchy- 
mosed spots in the synovial capsule, which is filled with a quan- 
tity of purulent exudate; even the ends of the bones may be 
injected and infiltrated by bloody entravasations. The heart and 
large vessels, in all recent cases, contain a large amount of fibrin ; 
and besides, we find different structural changes of the heart, 
such as pericarditis, endocarditis, and myocarditis, as complica- 
tions of the acute form of articular rheumatismus. 

Predisposition to this complaint seems to lie between the years 
of fifteen and forty. Early childhood and old age are generally 
exempt. Those appear most prone to the disease who have once 
been attacked by it; men more than women, and robust persons 
more than weak and debilitated ones. 

The most frequent Exciting Cause is exposure to cold and at- 
mospheric influences. Often we cannot trace its origin to any 
cause. It is found in all climates, though more in the middle 
than in the hot or polar zones ; and oftener in winter and spring 
than in summer and fall. 

Symptoms. — An attack of articular rheumatismus is frequently, 
though not always, preceded by a feeling of general debility and 
malaise, with occasional chilly sensations. Then the fever com- 
mences, and with it the pain in one or several joints. Soon these 
joints begin to swell, and sometimes to redden; the swelling is 
not, in all cases, proportionate to the pain. The disease either 
stays confined in the joint first attacked, or it spreads from joint 
to joint, attacking even the spine and the symphysis ossium pubis, 
rarely, however, the joints of the toes. The pain is generally ex- 
cruciating, worse from the slightest motion or contact, and yet 
the patient is sometimes tortured by a restlessness which compels 
him to move, notwithstanding the greatest pain. 

The fever, in some cases, runs very high, and the temperature 
of the body ranges at times between 104° and 104.9° F.; this is 
however, exceptional, as in most cases the temperature is not 
more than one or two degrees above the natural standard, and 
the pulse not higher than ninety to one hundred beats in a minute. 
In some cases we hear murmurs in the heart, even if not com- 
plicated with pericarditis; and the respiration is often accelerated. 
The skin transpires profusely without amelioration, and is often 



822 MOTORY APPARATUS. 

covered with a red or white miliary rash. The urine is generally 
scanty and saturated with urates and uric acid; which, on cool- 
ing, make a thick deposit. 

Its complication with endocarditis amounts, according to Bam- 
berger, to about twenty, and with pericarditis to about fourteen 
per cent. Complications with myocarditis are much less frequent, 
and those of pleuritis and pneumonia, meningitis cerebralis or 
spinalis, occur still less often. 

Its course is not at all a regular one, confined to a certain cy- 
clus. It may pass off in from eight to twelve days, and may 
torment many weeks. It very seldom terminates fatally, and 
then only in case of severe complication with affections of the 
heart, lungs or cerebral meninges. Its worst features are an 
increased liability to new attacks, and chronic derangement of 
the valves of the heart. 

2. Rheumatismus Articulorum Chronicus, Chronic Rheu- 
matism of the Joints. 

This form originates chiefly in the acute form, and consists of 
a subacute inflammation of one or more joints. Post-mortem 
examination, therefore, reveals the synovial capsule and liga- 
ments thickened, the cartilages of the bones spongiform, and the 
synovial fluid turbid. 

We may distinguish two forms. One in which single joints, 
often for months or even years, remain very painful to motion 
and contact, and show paroxysms of aggravation, chiefly in the 
night. On applying the hand to the diseased part, we often ob- 
serve a sense of crackling or crepitation within on moving the 
limb. The swelling of the joint may be considerable, or it may 
be absent; or the joint may only appear swollen, because the ad- 
jacent muscles have become atrophied, not being used on account 
of the pain. This may lead to a false anchylosis of the joint, 
rarely to the development of a tumor albus or arthrocace. 

The second form consists of frequently repeated attacks of acute 
articular rheumatism. Individuals subject to it are appropriately 
compared to barometers, as they feel, "in their bones," every 
little change in the weather immediately. It is often complicated 
with muscular rheumatism, and those forms of neuralgic and 
paralytic affections which are called rheumatic. 



RHEUMATISMUS MUSCULARIS. 823 

3. Rheumatismus Muscularis, Muscular Rheumatism. 
Myopathia ; Myalgia Rheumatica. 

To this form are assigned all those rheumatic affections which 
are seated in the muscles, tendons, fasciae, periosteum, and other 
fibrous tissues, joints excepted. Post-mortem examination fur- 
nishes little positive information as to the nature of the com- 
plaint. In some cases the muscles have been found interspersed 
by hard fibrous callosities; in others, some of the peripheric 
nerves were found thickened and grown together ; and in others, 
nothing at all could be detected. The pain is rather the most 
characteristic of all the symptoms; it is the so-called "rheumatic 
pain" — tearing, shooting, stitch-like, screwing, burning; some- 
times aggravated, and sometimes relieved by motion, rest, cold 
or warm applications, etc. The swelling and redness is seldom 
prominent, often entirely wanting. Its seat is of course quite 
variable, as it may attack any set of muscles in the body. Ac- 
cording to its location it has received different names, the princi- 
pal of which are ; 

Cephalalgia rheumatica, or that form which attacks the musculi 
frontales, occipitales, temporales, the galea aponeurotica, or the 
periosteum of the skull. 

Torticollis rheumaticus, Myalgia cervicalis — "stiff neck" — has its 
seat in the cervical muscles, and interferes much with the free 
movements of the head ; frequently draws the neck to one side, 
and may, if of long-standing, cause a permanent contraction of 
the muscles of one side of the neck — " wry neck." 

Pleurodynia rheumatica, myalgia pectoralis et inter costalis, attacks 
principally the pectoralis major and intercostal muscles. In the 
first case, it hinders the motions of the arms; and in the second, 
it interferes with respiration, and makes coughing and sneezing 
quite painful, simulating the pains of pleuritis. 

Omodynia rheumatica, myalgia scapularis, is of frequent occur- 
rence, having its seat in the muscles of the shoulders and back; 
it causes not only great pain on moving the arms, but also when 
moving the trunk to stoop or to turn. 

Lumbago rheumatica, myalgia lumbalis, kink in the back, attacks 
the lumbar muscles and the fascia lumbo-dorsalis. It is a pecu- 
liar feature of this affection that it frequently sets in instantane- 
ously: the individual having been moving about freely and 
without any pain^ may in the next minute be unable to rise 



824 MOTORY APPARATUS. 

from his chair; it comes like a shock, and may remain unabated 
for eight or ten days. 

THERAPEUTIC HINTS.— I have preferred to annex the necessary 
hints to the end of the chapter on the different forms of rheuma- 
tism, because it is not the pathologic form that indicates the spe- 
cial remedy; any one remedy may be indicated in either form; 
but it is the peculiarity of the individual case which points out 
the corresponding remedy. 

Aeon., when there is synochal fever* and restlessness; great 
thirst, dry, hot skin, and scanty, fiery urine; stitching pains in 
the chest, hindering free respiration, and great agitation of the 
heart, with anxiety. Articular rheumatism, with hot, pale or red 
swelling of the joints, shifting sometimes from one to another; 
after exposure to cold, dry wind. 

Amm. phosph., recommended by Kurtz for arthritis nodosa: the 
joints of the fingers, hands and back are swollen and bent: there 
is loss of appetite, emaciation, sleeplessness, nervous irritability, 
evening-fever. 

Ant. crnd., acute rheumatism, also gout, with gastric symptoms: 
nausea, vomiting, white tongue and great thirst at night. 

Apis, stinging, burning pain with great soreness and lameness 
of the affected parts, commences on right side and goes to left; 
cedematous swelling; profuse sweat brings relief. 

Apocyn. andr., rheumatism and gout; pain especially in the right 
shoulder and knee; pain in the joint of the big toe; bilious vom- 
iting, with or without diarrhoea; fever; nervous excitement; 
sleeplessness; constipation. 

Arnica, tearing pain, great soreness, numbness and swelling of 
the affected parts; worse on slightest motion, and especially 
when lying and getting warm in bed; fears even the possibility 
of being touched; complains constantly that the bed or couch 
whereupon he lies is too hard. Podagra; pleurodynia; pressing- 
pain in region of left side below heart, day and night. 

Arsen., burning, stinging, tearing pain, with pale swelling of 
the joints; great debility unto fainting: restlessness, anxiety, es- 
pecially at night; profuse sweat, which relieves the pain but 
leaves the patient terribly weak: frequent chilliness alternates 
with heat; the affected limb has to be moved constantly: exter- 
nal application of heat relieves; metastasis to the heart; aggrava- 
tion every other day. 



RHEUMATISMUS MUSCULARIS. 825 

Aur. mur., continued gnawing, boring pain deep in the joints, 
after the inflammatory swelling has subsided. 

Bellad., pressing, tearing, cutting pain deep in the bones, fre- 
quently running from the affected joint along the limbs like 
electric shocks; coming and going quickly; red, shining swelling 
of the joints; worse generally at night, from touch and slightest 
motion, even talking; attended with high fever, hot, dry skin, 
thirst, throbbing headache and pulsation of the carotid arteries. 
Lumbago, intensely painful sensation of cramp in the lumbo- 
sacral region and coccyx; can sit only for a short time and while 
sitting becomes quite stiff and unable to rise again for pain; 
crampy pains with stiffness in hip and ham, especially on left 
side. Torticollis, right sterno-cleido-mastoid contracted, no inflam- 
mation or pain. 

Benz. ac, tearing pains as if in the bones, from left to right and 
from below upwards; irritable bladder, urine of ammoniacal 
smell; syphilitic and gonorrhceal complications. Arthritis de- 
formans. 

Berber., lumbago, aching pain from above crests of ilia down- 
ward and inward to sacrum ; aching pain in bladder before and 
after micturition; burning micturition. (H.V.Miller.) 

Bryon., stitching pain, tearing pain, worse from slightest motion ; 
generally the patient does not want to move, but sometimes he is 
compelled to move by an overwhelming restlessness, notwith- 
standing the pain. The swelling is not principally confined to 
the joints and chiefly of a faintish redness, streaking out in dif- 
ferent directions. There is almost always loss of appetite, white 
tongue, feeling of dryness in the mouth without thirst, or else 
great thirst; nausea; pain in the liver or spleen; dry, hard stool, 
as if burnt; short breathing, with stitching pain in the sides of 
the chest; fever; sour sweats; easily irritated and angiy. Pleuro- 
dynia, omodynia, lumbago, muscular rheumatism in general; meta- 
stasis to the pericardium or pleura. 

Cact. grand., metastasis to the heart, with a sensation of constric- 
tion in the region of the heart, as if the heart were grasped and 
compressed, as by a band of iron. 

Calc. carb., chronic arthritis, with swelling of the joints, worse 
with every change of the weather; after working in water; also 
omodynia in right shoulder, or from the left shoulder down along 
the arm and towards the heart; lumbago, cold feeling in gluteal 
region and aching after Rhus tox., if it did not sufficiently relieve. 



826 MOTORY APPARATUS. 

Frequent sensation of coldness upon the top of the head; profuse 
sweat and coldness of the feet; great inclination to perspire; 
scrofulous diathesis. 

Calc. phosph., rheumatic pains in various parts of the body, but 
especially in places where bones are joined by symphises or 
sutures; worse in cold weather. 

Camphora., according to Kreussler, when the morbid process 
seems to yield under the influence of the proper remedies but for 
a short time and then comes back again, attacking part after part 
of the body, even internal organs. 

Carbol. ac, pains feel as if they would be increased by motion, 
but are not; pains come and go quickly, are worst in hip and 
shoulder-joints. 

Cauloph., rheumatism of the wrists and finger-joints, with con- 
siderable swelling; also when shifting from the extremities to the 
back and nape of the neck, with spasmodic rigidity of the muscles 
of the back and neck; panting breathing; oppression of the chest; 
high fever; nervous excitement; delirium. 

Caustic, tearing pain with stiffness and swelling of the joints ; 
contraction of the flexors ; the pain is worse on exposure to cold 
air, better in the warmth of the bed ; great weakness and lame- 
ness of the lower limbs and trembling of the hands. Chronic 
arthritis ; old warts on the eyebrows and nose. 

Chamom., drawing pain in the muscles of the upper or lower 
extremities, much aggravated during the night, with tossing 
about, as if beside himself, and great irritability of temper : hot 
perspiration, especially about the head ; redness of one cheek 
and paleness of the other. 

China, pain in all the limbs, worse especially from external 
pressure, so that he is even afraid of anyone coming near him, 
lest he might be touched ; bears hard pressure better than slight 
touch; intermittent character; great weakness; paleness of the 
face; bloated abdomen; after severe illness, loss of blood, etc. 

Cimicif., pleurodynia of the right side of the chest; pain worse 
from motion, extorting screams : articular rheumatism of the lower 
extremities, with much swelling and heat of the affected parts. 

Coccul, when the upper arm or thigh cannot be moved in their 
joints on account of a lame pain. 

Colonic, burning, tearing, or jerking pains : shifting : without 
swelling and redness, or with only a moderate, pale swelling : 
constant chilliness even near the hot stove, intermingled with 



RHEUM ATISMUS MUSCULARIS. 827 

short flushes of heat ; dry skin or profuse sweat, suddenly break- 
ing forth and disappearing again ; palpitation of the heart ; gas- 
tric symptoms before and during the attack ; Colchic. is said to 
be indicated especially when the acute form merges into the 
chronic, or when, during chronic rheumatism, acute attacks set 
in ; also in metastasis to the heart. 

Collin., has been given in diseases of the heart following acute 
rheumatism. 

Coloc, all sorts of pains, with sense of formication and numb- 
ness ; frequent urination ; skin cool ; chilliness with inclination 
to perspire. 

Digit, hurried, small pulse, easily affected by motion ; strong 
pulsations of the heart, with an indistinct and muffled sound of 
the heart ; hurried respiration ; hurried, abrupt speech ; almost 
complete suspension of the urinary secretion; shining, white 
swelling of the joints, not very sensitive to pressure ; a number 
of joints are attacked at once ; the whole body is pale. (Baehr.) 

Dulcam., chronic rheumatism, which gets worse from any little 
exposure to cold, or any change of temperature from warm to 
cold ; also when rheumatic pains set in after acute cutaneous 
eruptions, or when the chronic form alternates with attacks of 
intestinal catarrh. 

Ferrum, omodynia, either side; pain, especially in the deltoid 
muscle, of a constant, drawing, tearing, laming nature, worse in 
bed ; has to get up and to move slowly about ; worse, also, from 
being too lightly covered for any length of time ; face pale, flush- 
ing easily ; no swelling. 

Ferr. phosph., attacking one joint after the other without leaving 
the first ; joints puffy but little red ; high fever. Kink in the 
back. 

Gnaphal., gouty pains in the great toes. 

Graphit, arthritic nodosities on the fingers ; swelling of the toes 
and balls of the toes ; coldness of the dorsum of the feet. 

Guaiac., arthritic lancinations and subsequent contractions of 
the limbs; the pain is excited by the slightest motion and ac- 
companied by heat in the affected parts, especially when the pa- 
tient has been injured by mercury. It also promotes the sponta- 
neous breaking of gouty abscesses, relieving greatly the sufferings 
of the patient. 

Hamam., is recommended by Ludlam as "a local application to 
all kinds of articular rheumatism." The main characteristic of 



828 MOTOKY APPARATUS. 

Hamam. is the great soreness of the affected parts ; it may there- 
fore, no doubt, act quite favorably in cases where this soreness is 
a prominent feature. 

Iodium, in chronic arthritic affections, when they are charac- 
terized by a violent, nightly pain in several joints, without swell- 
ing ; previous abuse of mercury. 

Kali carb., stitching, tearing pains in joints; shuddering; chilli- 
ness ; nightly diarrhoea ; fulness and pressure in stomach after 
eating; frequent waking and desire to urinate, with burning; 
cold feet; hearing impaired ; noise in ears. (F. Schelling). Lum- 
bago, as if the small of the back were broken; pains shoot down 
back of thighs. 

Kali hydr., large doses, in chronic arthritis with considerable 
spurious anchylosis. (Hirschel.) 

Kalmia, the pains are shifting, changing location suddenly; 
deltoid rheumatism of both sides, but more particularly the 
right; tendency to affect the heart; slow pulse. 

Kreosot, when the rheumatic pain in the joints, especially in the 
hip and knee-joints, is associated with a feeling of numbness, loss 
of sensation, and a feeling as though the whole limb were going 
to sleep. 

Laches., rheumatic swelling of the index-finger and wrist-joint ; 
rheumatic pains in the knees, stinging, tearing, and sense of 
swelling ; swelling of the knees, with tension in the bend of the 
knees, difficulty in stretching the limb, and pain of the thigh 
(posteriorly) as if swollen ; bluish-red swellings. The pains are 
generally worse after sleeping ; they do not improve after profuse 
sweats ; the left side is generally the most affected ; or the affec- 
tion commences on the left and goes over to the right side. Ar- 
thritic contractions of the limbs after the abuse of mercury and 
quinine ; irregular action of heart, and valvular affection. 

Lacbnanth., torticollis, the neck is drawn to one side. 

Ledum, rheumatic pains in the lower extremities, in the hip 
and knee-joints, especially when they commence below and go 
upwards ; pains alternating with spitting of blood ; arthritic no- 
dosities with violent pains, which grow worse in the evening, 
when getting warm in bed, and last till midnight. 

Lith. carb., gouty disposition ; rheumatic soreness or sudden 
shocks in region of heart; pains in heart before and during 
micturition, also before and during the menses ; trembling and 
fluttering of the heart from mental agitation : valvular defit- 
ciences. 



KHEUMATISMUS MUSCULARIS. 829 

Lycop., the pain is mostly tearing, oftener on the right side, 
with and without swelling. In lumbago, if Bryon. has not suffi- 
ciently relieved, and the pain is worse from the slightest motion. 
In chronic forms, especially in old people, attended by forgetful- 
ness, vanishing of thoughts, congestion of the head, vertigo, 
wretched countenance, sour belching, nausea early in the morn- 
ing, flatulence in the stomach and bowels, causing great distress, 
constipation of the bowels, urine dark and turbid, or with sedi- 
ment of red sand, oppression of the chest from flatulence, palpi- 
tation of the heart, frequent flushes of heat with nausea, dry skin. 
The pain is generally worse at night; cannot bear covering. 

Mangan., arthritis vaga, shifting from one joint to another, or 
affecting cross-wise, with shining redness and swelling of the 
joints; burning spots about joints; pain worse from touch and 
motion, and at night, causing the patient to moan and groan 
constantly. Gout; left big toe swollen, with excruciating pain 
radiating upwards; must constantly change position. 

Menyanth., painful, spasmodic jerking of the lower extremities 
in gouty persons, with calcareous deposits in the joints. 

Mercur., tearing pain, not relieved by sweat, which is often very 
profuse and of a musty smell; worse at night, and in the warmth 
of the bed; worse also in cold and damp air; attacking joints and 
muscles, with and without swelling; or a mere puffiness of the af- 
fected parts, of a pale or slightly pinkish color; collection of saliva 
in the mouth of a copperish taste; slimy tongue; bitter or sweet- 
ish taste ; foul breath ; violent pain in decayed teeth ; swollen 
gums ; swollen glands of the neck, painful when swallowing ; 
griping in the bowels with diarrhoea, especially towards evening, 
with frequent urging ; constant feverishness; internal heat, with 
chilliness and perspiration; sleeplessness and restlessness at 
night; great debility. Complication with cardiac, pulmonary, 
pleural and meningeal inflammation. 

Nux vom., especially in rheumatism of the trunk, limbs not ex- 
cepted ; gout, in its incipient stage, in habitual drinkers ; over- 
sensitiveness to pain ; constipation ; during hard stool, violent 
pain in the affected part; scanty, dark urine; heat mixed with 
chilliness, especially when moving ; perspiration relieves. Torti- 
collis, head drawn to left side ; after fright. 

Phosphor., drawing, tensive pains, from slightest exposure to 
cold, with vertigo, oppression and sense of lameness and weak- 
ness in the lower limbs. 



830 MOTOR Y APPARATUS. 

Phytol., rheumatism of back and hip-joints. (A. E. Small.) 
Chronic form; obtuse, heavy, aching pain, generally worse in 
damp weather; with and without swelling; periosteal rheuma- 
tism with syphilitic taint ; nightly aggravation ; enlargement of 
the glands of the neck and axilla. 

Platina is recommended by Elb for the incipient state of endo- 
and pericarditis, in consequence of articular rheumatism, espe- 
cially when there is immense anxiety and great palpitation of 
the heart. 

Pulsat, drawing, tearing pain, frequently shifting from one part 
of the body to another, or attacking only one side ; usually at- 
tended by swelling and redness ; pale face ; slimy mouth ; bitter 
taste ; loss of appetite ; no thirst ; constant chilliness, with heat 
in the affected part; chilliness of left side; mild, quiet, tearful 
disposition; worse towards evening and at night in the warm 
room ; better from changing position and moderately moving 
about in the fresh air ; from drinking cold water and from un- 
covering the affected part. 

Rhodod., nightly drawing-pains in the periosteum from wet, 
cold and stormy weather ; worse during rest, disappearing when 
moving. 

Rhus tox., drawing, tearing pains in fibrous tissues, joints, and 
sheaths of the nerves, attended with a sense of lameness and for- 
mication in the affected parts, with or without swelling and red- 
ness, caused by exposure to wet, damp weather, to rain, by bath- 
ing or straining; worse during rest and when commencing to 
move; better from continued motion and dry, warm, external 
applications ; great restlessness. Lumbago. 

Ruta, wrists and feet; puffy swelling about the insteps; sour 



Sabina, chronic arthritis and gout ; the patient cannot bear a 
heated room ; he feels decidedly better in the cool air and in a 
cool room ; better from sitting erect, from moving and stretching; 
feeling of deep-seated inward trouble ; melancholy and sad. 

Salic, ac, inflammatory rheumatism of the joints, with great 
swelling and redness ; high fever and excessive sensitiveness to 
the least jar; motion impossible. 

Sanguin., right arm swollen, can't be raised, but moved laterally; 
sensation of coldness in arm, which no amount of clothing can 
remove ; stiff neck, pain in shoulder ; trapezius sore to pressure 
and painful on movement. 



GOUT, PODAGRA, ARTHRITIS. 831 

kink in back. (Schiissler.)' 

Silic, in chronic gouty nodosities. 

Spigel., when complicated with endocarditis or pericarditis. 

Spongia, with heart affection, wakening after midnight with 
sense of suffocation. 

Sticta pulm., inflammatory, articular rheumatism, especially of 
small joints, with circumscribed redness; subsequent synovitis, 
with exudation. (Price.) 

Sulphur, chronic rheumatism ; podagra; tearing, stitching pain; 
or when, after Bryon., the stitch-pain leaves, and a dull, aching, 
pressive pain remains ; sleeplessness ; hot head and cold feet. 

Tart, emet, lumbago; slightest effort to move causes retelling, 
cold, clammy perspiration and excruciating pain. 

Thuja, rheumatic and arthritic pains, especially of a sycotic or 
gonorrheal nature ; sweating of the parts not covered ; those 
which are covered keep dry ; sensation as if the whole body were 
very thin and delicate, and could not resist the least attack, as if 
the continuity of the body would be destroyed. 

Ver. alb., electric jerks in the affected limbs ; worse in bed ; 
necessity to sit up and let the legs hang out of bed, or must walk 
about. 

Ver. vir., rheumatism, especially in left shoulder, hip and 
knee ; also recommended in endocarditis and pericarditis. High 
fever ; red streak through centre of tongue, with coating upon 
either side. 

Zincum, general, articular rheumatism, with tearing pain, lame- 
ness, and trembling or crampy pain ; or twisting in the affected 
limbs, and frequent jerking of the whole body during sleep. 

4. Gout, Podagra, Arthritis. 

Gout differs entirely from rheumatism in the form of its at- 
tacks, (of w T hich, later,) by the overcharge of the blood with uric 
acid, by its never attacking children, and only grown persons 
after thirty years of age, and men oftener than women, especially 
such as are accustomed to a rich table and the habitual use of 
beer or wine, and who take very little bodily exercise. It is, 
therefore, a very rare occurrence to find a poor man suffering 
with podagra. According to statistics its main cause is a hered- 
itary disposition, which is generally aroused into activity by 
overcharging the blood with nitrogenized substances, and a want 
of exercise to consume the too-liberal supply. 



832 MOTORY APPARATUS. 

The repetition of diverse acute attacks of gout and its chronic 
form causes peculiar changes in the joints which it attacks. We 
find in and around them, besides the ordinary signs of inflam- 
mation, a chalky deposit, consisting principally of urate of soda, 
and less frequently of compounds of uric acid with lime, magne- 
sia and ammonia. This deposit either lines the internal surface 
of the synovial capsule like a soft mush, or incrustates the carti- 
lages of the bones as a hard mass, or even fills the whole joint as 
though it had been injected with plaster of Paris, growing hard 
and causing anchylosis. At the same time gouty deposits may 
take place on the external surfaces of the synovial capsule, on the 
tendons and in the surrounding cellular tissue, and give rise to 
hard nodosities, tophi. In some persons similar deposits have 
been observed on other and different parts of the body, especially 
in the skin. 

The course of an acute attack of gout is as follows : The gentle- 
man in question generally does not dream of what may happen 
to him over night. He feels fine; he has enjoyed a good dinner 
and supper as usual, the proof of which we can read in his face : 
his cheeks are full, round and of a florid complexion, only bis 
nose looks a little suspicious. There we observe a fine network of 
enlarged capillary blood-vessels, tinging it rather redder than 
would be necessarily required for a good-looking nose. He is fat, 
and his stomach and belly are in quite a prosperous condition, 
looking very well cared for. It ma} - be, though, that in the last 
few days he did not feel altogether right; his appetite may not 
have been quite as sharp, his sleep not quite as refreshing: he 
may have had some palpitation of the heart and his urine may 
have been saturated and turbid. All this, however, is generally 
overlooked or attributed to some imprudence in diet. Then, all 
at once in the night, generally after midnight, the gentleman is 
aroused by a burning, screwing pain in one of his big toes, which 
gets worse from hour to hour. If the toe were screwed between a 
vice, the pain could not be worse, and the poor sufferer, unaccus- 
tomed to such severe handling, moans and groans and tosses 
about without avail. The toe soon commences to swell and red- 
den; there is great thirst, high fever, dry skin, saturated urine 
and great mental irritability. Finally, towards morning, a remis- 
sion of the violent pain takes place; the day passes along com- 
paratively easy, until next night the same violent paroxysm 
recurs. In this way it goes on for about a week, when, finally, 



GOUT, PODAGKA, ARTHRITIS. 833 

the pain, redness and swelling gradually dissappear, and, at last, 
the skin of the affected toe peals off. This is a first attack 
of Podagra. Gout almost always commences in this way. In 
later attacks, however, other joints may become involved. If, 
then, it attacks the finger-joints, it is called Chiragra; if the 
knee-joint, Gonagra; if the shoulder-joint, Omagra. These acute 
attacks are at first far apart. Years may intervene between 
them, but finally the intervals grow shorter and the acute, 
regular attacks become chronic and irregular. 

Such chronic, irregular attacks often last for weeks and months, 
and always cause the above-stated deposits in and around the af- 
fected joints. They are generally not quite so painful, nor at- 
tended with as high a fever as an acute, regular podagra : they 
are always preceded by digestive derangements, and they attack 
several joints at the same time. After the attack subsides, the 
swelling does not, but remains at first soft and doughy, until at 
last it changes into a hard tophus, which grows with each subse- 
quent attack. Such hardened, chalky deposits within the joints 
frequently give rise to the formation of abscesses, which break 
and discharge masses of pus mixed with calcareous substances. 

At still other times this morbid process attacks internal organs, 
such as the stomach, brain or heart; then it is called anomalous 
gout. 

Gout of the stomach manifests itself as a very severe cardialgia, 
with violent vomiting, frequently even of blood ; Gout of the brain, 
as a kind of apoplexy, or violent headache, vertigo, furibund de- 
lirium, and subsequent stupidity and sopor; and Gout of the heart, 
as irregular palpitation of the heart, disturbed circulation, dysp- 
noea and syncope. 

It might be quite difficult to diagnosticate these spells as gout, 
if it were not that they are almost always preceded or succeeded 
by gouty manifestations on the peripheric organs. This settles 
the question. Gout is a stubborn disease, but is not fatal unless 
complicated with other diseases, or in consequence of the organic 
mischief which it produces in the course of time, in the form of a 
lingering cachexia, or apoplexia, or angina pectoris. 

THERAPEUTIC HINTS.— As the principal exciting cause of its 
first development is high and lazy living, this, of course ought to 
be stopped, as a first step. 



834 MOTORY APPARATUS. 

In acute attacks the following are principally indicated: Aeon., 
Arnica, Arsen., Bryon., Calc. carb., Sabina, Sulphur. 

In chronic gout the main remedies are: Amm. phosph., Calc. 
carb., Caustic, Coloc, Guaiac, Iodium, Lycop., Mangan., Natr. 
mur., Sabina, Silic, Sulphur. 

For special hints compare Rheumatism. 

5. Arthritis Deformans. 

"This disease, also described under the names of Arthritis sicca, 
spuria, nodosa, pauperum, rheumatoides, arthroxerosis, Malum senile, 
articulorum, Rheumatismus nodosus, Polypanarthritis, Rheumatic gout, 
Nodular gout, is applied to an inflammatory process of the joints, 
which produces chronic changes but never suppuration of the 
joints. It affects the nutrition of all the constituent parts of the 
joint, causing, on the one hand, abnormal proliferation, on the 
other, absorption; and so the whole shape of the joint becomes 
deformed." (Senator.) 

There are two varieties of arthritis deformans, one beginning in 
the smaller joints of the extremities, and the other, in the larger joints 
of the trunk (vertebral column, hip), subsequently extending to- 
wards the periphery, and by preference called the "senile" form. 

The peripheric variety is much more common in women than 
in men, and is essentially a disease of the poorer classes. Devel- 
oping towards the thirtieth year of life, it increases in frequency 
among Avomen about the climacteric period, and is caused chiefly 
by prolonged exposure to cold and damp, by inadequate food, 
debilitating haemorrhages, unduly protracted lactation, grief and 
anxiety, by manual labor (sewing, knitting, laundry-work, in 
women, watch-making, in men). 

The senile variety is more common in men than in women ; it 
begins at the age when senile changes (atheromatous degeneration 
of the arteries, calcifications, etc.) commence to develop, and it 
attacks the rich no less than the poor. Thin people appear to be 
specially predisposed to it, 

The Symptoms consist of neuralgic pains in the parts affected, 
which lose by slow degrees their mobility; the articular ends of 
the bones become thickened, and gradually displaced, and when 
moved produce a peculiar grating, which can be distinctly felt 
through the soft parts. There are also not seldom excrescences 
and nodular masses around the joints, while the muscles and 



RACHITIS, RICKETS. 835 

soft parts in the neighborhood of the joint, or even of the entire 
limb begin to waste. In the smaller, peripheral joints the disease 
spreads invariably symmetrical, which appears not quite so obvi- 
ous in the senile form. The fingers from the index to the ring- 
fingers, more rarely the little finger also, are flexed and dislo- 
cated at the metacarpal end of the first phalanges, usually to- 
wards the ulnar side, less frequently towards the radial side. 
The thumbs generally remain free, while the great toes are more 
frequently and more severely attacked than their neighbors. 
An attack of the hip and knee, shoulder or elbow-joints shortens 
the respective limb; an attack of the vertebral column (spondylitis 
deformans) produces stiffness and rigidity of the spine, with pains 
radiating from the back ; an attack of the cervical vertebrae pre- 
vents bending or rotating the head ; an attack of the dorsal and 
lumbar spine shortens and twists the body. Cases occur where 
even the lower jaw, the clavicles, in fact all the joints of the body 
became implicated. 

The process of the disease is very slow, but steadily progressing 
in paroxysms which are usually attended with severe pain and 
slight febrile disturbances. The urine shows a diminution in the 
amount of phosphoric acid. 

THERAPEUTIC HINTS.— Calc. phosph., Phosph. ac. Compare 
the hints under Rheumatism. 



Rachitis, Rickets. 

Other names by which this disease is known are : Raclritisnnis. 
Morbus anglicus, Articuh duplicati, Zweiwuchs, Doppelte Glieder. Its 
character consists essentially of an irritation of the osteo-plastic 
tissue in consequence of which there is an overgrowth of the 
same, with less earthy salts than are required for the formation 
of healthy bone. Heitzmann asserts that this irritation of the 
osteo-plastic tissue be brought about by the influence of lactic 
acid (phosphorus exerts a similar influence), and that, when 
combined with a deficiency of lime in the food, it be capable of 
producing true rickets. This supposition agrees with the fre- 
quency of its development during the first two or three year- of 
life, and with the fact that an excess of lactic acid has been de- 
tected in the urine of rickety children. After the third year the 
disease develops much more rarely, and between the age of five 



836 M0T0RY APPARATUS. 

and puberty it is quite an exceptional phenomenon ; sometimes 
it develops already in utero. 

As Causes have been mentioned: hereditary influences, chronic 
tuberculosis in the father, constitutional syphilis in the parents ; 
cold, damp, ill-ventilated dwellings. 

Its Premonitory Symptoms are : intestinal and bronchial ca- 
tarrh, feverishness and restlessness towards evening and through 
the night, perspiration about the head, slow, irregular teething. 
After a while changes in the bony structure become apparent. 
The articular ends of the long bones swell. 

The prominence of the contiguous epiphyses, for instance of 
the upper and lower arms, is so marked, that the joint between 
them forms a depression which gives the appearance of two el- 
bows, hence the name Articuli duplicati, or Zweiwuchs (double 
growth). The fontanels and sutures of the skull delay closure, 
and the occipital bone becomes soft and flexible, and may often 
be depressed by the finger as though it were of parchment. This 
softness extends over the entire bony structure, and is the cause 
of the deformities which the bones undergo in consequence of the 
force of the muscles attached to them and of the weight of the 
body. The legs usually exhibit an outward curve and become 
bow-shaped, while the thorax appears laterally compressed, caus- 
ing the breast-bone to project like the keel of a boat (chicken- 
breast). The junctions of the ribs with their cartilages become 
thickened and nodular, and appear like the beads of a rosary. 
The spine often becomes curved, the pelvis flattened in its antero- 
posterior diameter, or otherwise deformed, and the growth of 
the child in length delayed. The hairy part of the head is un- 
checked in its growth, and the head seems unduly big and often 
sinks down between the shoulders ; the abdomen is very promi- 
nent, and in advanced cases the child looks like a dwarf. 

In mild cases or such as come early under judicious treat- 
ment, the deformities do not reach this grade ; by a renewed ac- 
tivity of growth the morbid process may be checked without 
leaving any marked thickening of the bones behind. 

There have been observed some cases of an acute nature in 
which within a few weeks the epiphyses of all or of most of the 
long bones become swollen, where there were swellings on the 
cranial bones, and a simultaneous swelling of the gums and pal- 
ate, with digestive derangements and fever, the whole process 
running its course within a period of a few weeks, terminating 



MALACOSTEON. So , 

either in recovery, or in death by complications, such as pneu- 
monia, meningitis, etc. 

THERAPEUTIC HINTS.— It ought to be ascertained, whether the 
milk which the child receives is of a proper condition. When 
the child has been fed on paps and other mere farinaceous food, 
its diet ought to be changed to nitrogenous substances, such as 
rare beefsteak, mutton chops, etc. 

When, notwithstanding the most proper kind of nourishment, 
the disease still develops itself, the child needs medicinal aid. 

For the preceding chronic diarrhoea compare the corresponding 
chapter. 

For the swelling of the bones compare — 

Aselli jecoris oleum, which is best used in the form of a tritura- 
tion with sugar. It is not at all necessary to give the oil by the 
spoonful. 

Bellad., curvature of the lumbar vertebrae ; squinting ; enlarged 
pupils ; pain in the throat when swallowing ; thick, protruding 
belly. 

Calc. carb,, slow, difficult teething ; profuse sweating about the 
head ; fontanels open ; abdomen enlarged ; whitish, frothy diar- 
rhoea; curvature of the spine and deformities of the extremities. 

Calc. phosph., not less important than carbonica; its principal in- 
dications are the fontanels, which remain wide open, the diar- 
rhoea and the emaciation of the child. Both the Calc. carb. and 
phosph. have been administered in large, crude doses with far 
less good results than in a fine homoeopathic preparation. 

Previous abuse of mercury may call for Asaf., Aurum, Hepar, 
Iodium, Sulphur; and still other peculiarities of the case may 
point to Angust., Fluor, ac, Lycop., Mercur., Mezer., Phosphor., 
Phosph. ac, Sepia, Silic, Staphis., Symphytum, and others. 

Malacosteon ; Mollities Ossium : Osteomalacia, Softening 
of the Bones. 

Rachitis consists of a deficient calcification of the growing bone, 
malacosteon, on the contrary, of a gradual withdrawal of earthy 
salts from the already formed bony structure. It is a chronic 
disease peculiar to adult life, and especially to women who have 
passed through one or more pregnancies. It usually begins dur- 
ing pregnancy, with an active congestion and proliferation of cor- 



838 MOTOEY APPARATUS. 

puscular elements, which is followed by the removal of earthy- 
salts. The real cause of this decalcification of the bones is still 
a matter of conjecture. Damp dwellings, however, seem promi- 
nent among the exciting causes. 

Malacosteon is a very rare disease. In some cases the morbid 
process is confined to the pelvis and spine, in others it spreads 
over all the bones of the skeleton. The calcareous constituents 
being extracted, it is obvious that the whole frame loses its form. 
In this way originate curvatures of the spine; the pelvis, from 
the pressure of the legs, flattens in on both sides and projects in 
front with its pubic region; the extremities become flexible, 
yielding to any pressure in any direction, and in some cases it 
has been observed that women of a stately size gradually shrunk 
down to a dwarf's figure. 

The disease commences with severe boring and tearing pains 
in the affected bones, worse on motion and better at rest, and 
usually attended with more or less fever ; the saliva and secre- 
tions of the skin are said to contain appreciable quantities of 
phosphate of lime; the general condition may, in some cases, for 
a long time be not essentially affected, while in others the gen- 
eral system shows early signs of a deep-seated cachexia. 

THERAPEUTIC HINTS.— I do not find a single case mentioned 
in our literature. However, Arnica, Rhus tox., or Symphytum, 
after difficult confinement ; and Calc. carb. and phosph., Fluor, 
ac, Phosphor., Silic, and others, as constitutional remedies, 



Progressive Muscular Atrophy. 

The character of this disease consists in a gradual atrophy and 
fatty degeneration of certain muscles, which in the course of time 
spread further, involving progressively more and more of the 
muscular tissue. 

On post-mortem examination, we find, therefore, (1), the muscles 
diminished in size; (2), the muscular fibres changed from red to a 
pale and yellowish color. On applying the microscope it appears 
that this process commences with a change of color of the muscu- 
lar fibres which are growing paler and a disappearance of their 
transverse striae. Later we observe fat-globules in the centre of 
the ultimate fibrils, and at last a disappearance of the fibrils 



PROGRESSIVE MUSCULAR ATROPHY. 839 

themselves, so that the sarcolemma or sheath which envelopes 
the ultimate fibrils, shrinks together, containing only single fat- 
globules. 

This degenerating process does not take place simultaneously 
in all the fibres of a muscle ; we find on the contrary in the same 
muscle fibres thus degenerated and others perfectly healthy, un- 
til by degrees all are involved in the same morbid process. 

Some authors have thought, that this morbid process within the 
muscles be the consequence of a disease of the nerves at their 
roots, because in some cases there have been found on post- 
mortem examination quite conspicuous structural changes in the 
anterior roots of the spinal nerves. Yet in other cases nothing 
of the kind could be detected. And as the muscle retains its 
susceptibility to the electric currents as long as there are any 
muscular fibres left, whilst in the case of degeneration of the 
peripheric nerves this susceptiblity to the electric current leaves 
at quite an early stage : it seems to follow, that those authors are 
right, who have considered the progressive muscular atrophy as 
a primary affection of the muscles themselves. 

It is found in all classes of people ; seems, however, to attack 
women oftener than men ; appears to be in some cases hereditary 
and in others brought on by overexertion of the muscles, or by 
taking cold ; whilst in still others it could not be traced to any 
special cause. 

This disorder creeps on very slyly, mostly without any pain or 
any other apparent disturbance of the body. Commencing gen- 
erally in the muscles of one hand or one shoulder, or in the mus- 
cles of the neck, rarely in the muscles of the face ; the first appa- 
rent symptom is a weakness in the parts involved, a loss of mus- 
cular power, which is associated by a diminution of their volume. 
The attacked parts grow flat and -shrink away. We find there- 
fore in such cases the prominent muscles of the thumb gone, and 
the spinal processes sticking out, when the muscles of the neck 
have become atrophied. If these atrophied muscles are exposed 
to a cold draught of air (if we for example blow upon them), we ob- 
serve at once a vibratory motion of the muscular fibres, a jerking 
of single fasciculi. This is quite a constant symptom of the dis- 
ease. Its pathognostic sign, however, is the susceptibility of 
these muscles to the electric current, which causes a contraction 
in them, as long as there are any fibres left, distinguishing it thus 
from any paralysis which has its cause in a morbid condition of 
the nerves. 



840 MOTORY APPARATUS. 

The atrophy and fatty degeneration and consequent paralysis 
may stay confined to the parts first attacked, but in other cases 
it creeps on, involving progressively all the muscles supplied by 
the cerebro-spinal nerves, with the exception of the muscles of 
the heart and the intestinal canal. Thus gradually, in these ter- 
rible cases, the patient becomes incapable of moving himself, of 
feeding himself, of expressing any mental emotion by his face ; 
of talking, and lastly, even of swallowing. It takes years, before 
death releases him out of this terrible bondage, if not intercurrent 
disease shortens his sufferings. 

THERAPEUTIC HINTS.— The electric current, by induction or 
faradisation, persistently used, has improved cases where the 
disease remained confined to single parts of the body. 

Arg. nitr., Arsen., Cuprum, Plumbum, Caustic, Laches., Sulphur. 



Osteitis, Caries, Necrosis, Exostosis. 

Osteitis is an inflammation either of the periosteum, or of the 
bone itself, or of its diploe or its medullary membrane, or of all 
these different structures together. It may be caused by external 
injuries, such as fractures, bruises etc., or by chemical influences; 
or it may be the consequence of certain constitutional contamina- 
tions, like a scrofulosis, arthritis, scurvy, syphilis, mercurial 
poisoning, or suppressed acute or chronic skin diseases. 

Its symptoms generally consist of a deep-seated, heavy, boring 
pain, which assumes a tearing character when the periosteum is 
affected at the same time. This pain is usually worse at night 
(especially if of syphilitic origin) and worse also from pressure 
and motion. There is generally a feeling of heat in the bone, and 
if the inflamed bone is superficial, its integuments soon partici- 
pate in the inflammatory process. Febrile actions are mostly 
wanting, except in acute cases. Such an inflammation may ter- 
minate in 

Caries, by which we understand an ulceration of the bony struc- 
ture; or even in 

Necrosis, which means a dying off of a portion of the bony struc- 
ture, which, in favorable cases, is gradually thrown off and re- 
placed by a new formation. 

In other cases the inflammation causes an exudate upon the 
bone, which hardens and stows fast to the bone, thus augment- 



OSTITIS, CARIES, NECROSIS, EXOSTOSIS. 841 

ing its natural size more or less considerably; this is called 
Exostosis. 

THERAPEUTIC HINTS.— August, caries, especially of the long 
bones; great longing for coffee, the use of which must be entirely 
prohibited; great sensitiveness of mind, very touchy, easily irri- 
tated from the least provocation. 

Asaf., osteitis, caries in scrofulous individuals, and after the 
abuse of mercury ; bluish redness and swelling of the external 
parts ; ulcer with bluish hard edges, which are very painful to 
the slightest touch; discharge of thin, very offensive pus. Pulsa- 
tions in the pit of the stomach, perceptible to the eye and hand; 
ill-humor and irritated mood. 

Aselli jecor. ol., in different affections of the bones, in scrofulous 
subjects, especially when the extremities of the bones are affected; 
fistulous ulcers, with raised edges, easily bleeding, and discharg- 
ing a flocculent pus and ichor of a nauseating smell. 

Aurum, caries of the nasal bones in consequence of ozama, diffus- 
ing a most horrid odor; caries of the cheek bones and exostosis 
of the skull and other bones, with boring pain, after the abuse of 
mercury. 

Aur. mur., caries of the left external malleolus, after allopathic 
drugging. (Linsley.) 

Bellad., scrofulous individuals w r ith glandular swellings, crusts 
on the corners of the mouth and sore, swollen and bent vertebra?; 
exostosis on the forehead, and caries of the palatine bones. 

Calc. carb., osteitis, with swelling ; caries and necrosis of scrofu- 
lous individuals; diarrhoea, hard, bloated abdomen; chronic 
symptoms on the scalp ; emaciation. 

Calc. phosph., for similar affections, and especially after fractures, 
when the callus does not ossify. 

China, caries, especially where there is profuse suppuration. 

Fluor, ac, caries in consequence of syphilis or abuse of mercury ; 
caries of the temporal bone. 

Iodium. 

Lycop. 

Mercur, osteitis, caries ; pain, as if the part were broken. 

Mezer., periostitis and swelling of the bones, especially on the 
tibia, with the most violent nightly pains in the bones. 

Nitr. ac, especially in syphilitic affections and after the abuse 
of mercury. 



842 MOTOKY APPARATUS. 

Phosphor., exostosis on the skull, with violent tearing and bor- 
ing pains, worse at night; swelling of the glands of the neck; 
sour belching and vomiting; burning in the mouth, oesophagus 
and stomach; constipation; emaciation; fainting when raising 
the head ; lame weakness of the extremities. 

Phosph. ac, osteitis, and also when after an external injury of 
the periosteum there remains a feeling as though the bone were 
scraped by a knife. 

Ruta, periostitis and pains in consequence of external injury, 
with erysipelatous inflammation of the external parts. 

Silicea, one of the most important remedies in the different 
affections of the bones, with fistulous openings and discharge of 
thin pus and bony fragments. 

Staphis. is recommended, especially in osteitis of the phalanges 
of the fingers. 

Sulphur, after suppressed itch and mercurial poisoning. 

Tuberculosis of the Joints, White Swelling. 

Tuberculosis being a constitutional disease, may localize itself 
in various parts of the body. When localizing in the joints, it 
attacks by preference the hip-, knee-, ankle-, elbow-, or wrist- 
joints, and was called by older writers, on account of the peculiar 
glossy, shining appearance of the affected joint, "white swelling." 
" In its incipiency we find the synovial membrane injected, some- 
what opaque, and here and there softened or thickened by fibrous 
exudation. There is effusion of lymph, which assumes a pulpy 
consistence of a pale yellowish or greenish color. The articular 
cartilage is of a dull whitish or slightly grayish aspect, and some- 
what thickened, softened and partially separated from its osseous 
connections. The cancellated structure of the bones is abnormally 
vascular, light, porous, humid, and at the same time easily broken 
and cut. Not unfrequently its cells are distended, with yellowish 
tubercular matter, of a semi-solid, osseous consistency: or, this 
substance presents itself in the form of distinct masses, free or 
encysted, and, perhaps, not larger than a millet-seed. The liga- 
ments appear abnormally red, tumefied and softened. The sy- 
novial fluid is generally increased in quantity, but rarely to any 
considerable extent. In its further progress, the lymph gradually 
increases in quantity, and is often intermixed with a little sero- 
purulent matter, or thick, greenish-looking pus. The synovial 



COXARTHROCACE, COXALGIA, HIP DISEASE. 843 

membrane is partially destroyed, and what remains is of an 
opaque, muddy and ragged appearance. The cartilage is ulcerated, 
pulpified, discolored, perforated and almost completely detached. 
The bony structure is very red, soft, carious, rough, and easily 
crumbled. The ligaments exhibit well-marked signs of inflamma- 
tion, being loose and spongy at one joint, attenuated at another, 
and perhaps thickened or hypertrophied at a third. In this way 
the structures of the joint are completely subverted, with hardly 
any trace of their original appearances. Pus is more usually seen, 
often, indeed, in large quantities, sometimes thick, pultaceous, 
caseous, ichorous or sero-sanguinolent. In some instances it is 
very thin and almost black, evidently from the effects of the 
necrosed condition of the bones. 

" In case of recovery, the joint will be found to be filled by a 
white, fibrous, organized substance; the extremities of the bones 
being anchylosed, or firmly attached by new matter to the sur- 
rounding structures. It is very rare that a new socket is formed ; 
and yet this is not impossible. In time, the artificial joint may 
admit of considerable motion, but, in general, this is extremely 
restricted. Occasionally an imperfect ligament is formed round 
the bony remnants, and the surface of these bony remnants may 
even become slightly tipped with cartilage. Finally, osseous 
growth — short, irregular and friable — sometimes make their ap- 
pearance upon the bones, in the vicinity of the former disease." 
(Gross.) 

This is the general character of the pathological changes which 
tuberculosis causes, when located in the joints. I shall now speak 
of the several joints which it attacks in preference, causing affec- 
tions which are not unfrequently met with in practice. 

Coxarthrocace, Coxalgia, Hip Disease. 

This affection is most frequently found from the third to the 
seventh year. Growing out of a constitutional diathesis, it may 
be excited by external injuries, exposure to cold, or different, 
Avasting diseases; sometimes it comes on stealthily without any 
appreciable cause. It seldom, or never, attacks both hip-joints, 
but is frequently complicated with psoas abscess, ophthalmia, 
pulmonary phthisis and degeneration of the lymphatic glands. 

In its first stage, we observe that the child is easily tired, and 
complains of a pain in the knee, on the inner side, which is worse 



844 MOTOKY APPARATUS. 

from motion, so that the child limps when walking; this pain is 
likewise worse in the night, and frequently attended with 
spasmodic jerking of the extremity, disturbing sleep. The knee 
itself shows neither swelling nor discoloration. Gradually the 
pain extends to the thigh and leg, and in some cases it is felt 
most keenly in the tendo Achillis, or over the instep; or it shifts 
from one place to another; or may disappear for a short time 
entirely. Finally, after weeks and even months, the pain is also 
felt in the hip and its neighborhood; and then most intense and 
persistent directly over the articulation, deep-seated and of a dull, 
gnawing character. Up to this time there is no perceptible im- 
pairment of the general state of the system. By and by, however, 
during the second stage, when the pain in hip and knee increases 
still more in violence, when the buttoc,k flattens, the gluteo- 
femoral crease disappears and the limb apparently grows longer, 
with nightly spasmodic twitchings and wasting of its muscles: 
then we also find the sleep habitually disturbed by unpleasant 
dreams, and frequent starting of the patient out of sleep with 
crying and screaming; the appetite becomes impaired, the bowels 
often constipated, and there is more or less fever, especially at 
night, followed frequently by copioils sweats. Now the patient 
begins to show a care-worn countenance; he grows peevish and 
irritable, and loses flesh and strength. 

In the third stage matter forms within the diseased joint. " This 
is indicated by an increase of pain on the slightest motion ; by a 
sense of throbbing and tension, deep and persistent ; by severe 
swelling of the gluteal region, generally most prominent at the 
centre of the articulation ; by oedema of the subcutaneous cellular 
tissue ; by a remarkably turgid and enlarged condition of the 
subcutaneous veins; by violent rigors, followed by high fever 
and copious sweats. As the matter increases in quantity, it grad- 
ually works its way towards the nearer surface ; its approach be- 
ing denoted by the occurrence of a circumscribed, erysipelatous 
blush. Here there is generally distinct fluctuation, and the parts, 
feeling soft and baggy, soon yield at one or more points, followed 
by the escape of the contents of the sac." (Gross.) 

These openings may in different cases form in different places : 
in the gluteal region, either directly above the joint, or in its im- 
mediate vicinity ; on the upper and back part of the thigh, below 
the great trochanter; on the upper and inner surface of the thigh : 
on the superior and external part of the groin ; on the sacro- 



COXARTHROCACE, COXALGIA, HIP DISEASE. 845 

sciatic notch ; or on several points, either simultaneously or suc- 
cessively. Or the matter may partially escape internally, when 
the bottom of the acetabulum is perforated, into the rectum, 
bladder or vagina ; or it may collect in a sort of pouch, between 
the inner surface of the iliac bone and the soft parts of the pelvis. 
By this time the limb has actually grown shorter from one 
inch and a quarter to several inches, and the foot points either 
directly forwards and outwards, but oftener inwards. The thigh 
is generally flexed upon the pelvis, and turned either towards 
the sound limb or is bent off from it. The great trochanter gen- 
erally lies directly over the acetabulum, or in its immediate vicin- 
ity ; whilst the head and neck of the femur are usually so much 
wasted as to exist only in a rudimentary form. Dislocations of 
the femur are exceedingly rare ; and are possible only in such 
cases where there is ah extensive destruction of the soft parts ; 
allowing the superior extremity of the bone to move about, and 
to insert itself into a new position. 

THERAPEUTIC HINTS.— Arsen., third stage ; the child is emaci- 
ated, exhausted; very restless; has diarrhoea, worse in the mid- 
dle of the night ; wants to drink constantly, but little at a time. 
It is indeed going fast if Arsen. should not soon change the scene 
for the better. 

Bellad., burning, stinging in the articulation ; nightly aggrava- 
tion, with starting in sleep, fever, and congestion of the head ; or 
drowsiness, with inability to go to sleep. Cramps in glutei mus- 
cles ; outer hamstring feels as if contracted ; inability to walk. 

Calc. carb., second stage; sweat on the head during sleep; 
scratching the head impatiently when getting awake ; frequent 
desire for boiled eggs ; abdomen hard and bloated ; inclined to 
diarrhoea, especially towards evening; glandular swellings on 
the neck. 

Calc. phosph., third stage ; it puts an end to the further destruc- 
tion of the bone, stops suppuration and promotes new organization. 

Carb. veg., third stage ; ichorous, offensive, blackish discharge ; 
deeply-sunken state of the whole organism. 

China, profuse suppuration, sweat, and diarrhoea. 

Coloc, second and third stage; difficult urination of dark urine; 
green diarrhoea ; lies upon the affected side with bent-up knee ; 
the pain is of a crampy nature, as though the parts were screwed 
in a vice. 



846 MOTORY APPARATUS. 

Hepar, suppurating stage, with fever and sweat, where the pa- 
tient wants to be tightly covered. 

Iodium, intermittent, sharp, tearing pain between the left hip 
and the bead of the femur, increased by moving the joint; 
glandular swellings ; abuse of mercury. 

Kali carb., third stage ; crampy tearing in the hip-joint and 
knee ; bruised pain in the hip-joint when moving and sneezing ; 
twitchings of the muscles of the thigh ; dull pain in the side of 
the knee when walking, and especially when extending the limb; 
starting when asleep ; twitching of the limbs during sleep : all 
the symptoms worse towards three o'clock a.m.; great tendency 
to start, especially when being touched. 

Laches., in any stage, if there be a regular aggravation of febrile 
motion in the afternoon about three o'clock, an aggravation of 
general malaise after sleep, a notable offensiveness of the alvine 
discharges, even if of a natural consistence, and previous abuse 
of mercurial preparations ; before or after Laches, is frequently 
indicated 

Lycop., when there is an aggravation of fever and suffering, es- 
pecially from four to eight o'clock p.m. ; great fear of being left 
alone ; violent jerking of the limbs and body, awake and asleep, 
and great crossness on awaking out of sleep. 

Mercur., first and second stage, with prominent aggravation in 
the night, restlessness and inclination to sweat ; is frequently in- 
dicated before or after Bellad. 

Phosphor., hectic fever ; dry, hacking cough ; chronic diarrhoea : 
urine turbid on voiding, precipitating a white sediment on cool- 
ing; thin, watery pus oozing from the diseased joint. 

Rhus tox., first and second stage; on pressure upon the tro- 
chanter, pain in the hip-joint; pain in the knee predominant: 
swelling of the glands of the neck ; crusty eruptions on face and 
head ; after exposure to rain ; worse in damp, cold weather. 

Silic, in suppuration and caries of the bones anywhere, one of 
the most important remedies ; pale, earthy complexion ; loss of 
smell and taste; stoppage of the nose or acrid coryza ; the parts 
upon which one lies easily go to sleep : any little sores or wounds 
are apt to fester ; glandular swellings. 

Stramon., according to Dr. Jeanes. always indicated when the 
left hip is affected. I have given Stramom. with great success 
wherever abscesses form, if attended with violent pain, driving- 
one mad. 



GONARTHROCACE, TUMOR ALBUS GENU. 847 

Sulphur., psoric individuals ; frequent redness and inflammation 
of the eyelids; heat of the head, and cold hands and feet; fre- 
quent red spots in the face ; is averse to being washed ; morning- 
diarrhoea, or constipation ; sleepy in the daytime, and wakeful at 
night ; easily perspiring. 

Gonarthrocace, Tumor Albus Genu, White Swelling of 
the Knee. 

Gonarthrocace, growing upon the same constitutional contami- 
nation as hip-joint disease, runs through nearly the same phases 
as that disease, and is most frequently excited by an external in- 
jury, such as a fall, twist, or blow upon the knee. 

At first there is a severe, dull, heavy, gnawing pain at the inner 
condyle of the femur, at the lower part of the patella, or at the 
inside of the head of the tibia ; seldom at the outer part of the 
joint ; it may be intermitting, and it may be continuous in its 
character, extending up' and down the limb, and depriving the 
patient of all sleep and rest. 

After a Avhile the parts commence swelling, owing partty to in- 
terstitial deposits, and partly to an increase of synovial fluid. 
This swelling is at first most conspicuous in front and at the sides 
of the patella, effacing the normal depressions in that region, and 
replacing them by soft, fluctuating bags. " A similar prominence, 
often of great size, exists just above the joint, over the lower part 
of the femur, bounded interiorly by the patella, and on each side 
by the lateral ligament, its anterior wall being formed by the 
tendon of the exterior muscle. Very little tumefaction ever oc- 
curs in the popliteal region, even in the more advanced stages of 
the disease. The skin is tense and glossy ; the subcutaneous 
veins are abnormally large; the knee is stiff, if not immovable; 
and the leg, more or less flexed, is swollen and cedematous, while 
the thigh is remarkably atrophied. In proportion as the liga- 
ments yield, the deformity of the joint increases, owing chiefly 
to the displacement of the head of the tibia, which allows the 
muscles to draw the leg outwards, so as to give it a twisted and 
contorted appearance. Occasionally, though rarely, there is an 
actual enlargement of the diseased bones. The fluctuation, which 
constitutes so prominent a symptom in the earlier periods of this 
complaint, often, in a great measure, if not entirely, disappears 
during its progress, owing to the adventitious deposits upon the 



848 MOTOKY APPARATUS. 

synovial membrane, and the absorption of the redundant syn- 
ovial fluid. Whenever this is the case, the swelling, instead of 
being soft and yielding, will be comparatively firm and resisting; 
but it still possesses some degree of elasticity, often so deceptive 
as to lead to the idea that the joint contains a good deal of fluid, 
and which nothing but the most careful examination can dispel." 
(Gross.) 

Lastly, though not always, the involved structure commences 
to suppurate, and the matter may either be absorbed, or may 
escape at different places about the knee — very rarely, though, 
in the ham — forming numerous fistulous openings, and leading 
to caries and necrosis of large portions of the diseased bones. 

THERAPEUTIC HINTS.— Aeon., after exposure to severe cold. 

Arnica, after a fall or blow, and Rhus tox., after a twist, sprain or 
strain, may severally be entirely sufficient to ward off all serious 
consequences. 

Arsen., third stage ; discharge of fetid pus ; oedema of the legs ; 
hectic fever; sleeplessness; emaciation; exhaustion. 

Bellad., red, shining swelling, with throbbing pain and enlarged 
blood-vessels along the limbs. 

Bryon., pale swelling, with stitching pain from slightest motion. 

Calc. carb., scrofulous individuals; too early and too profuse 
menstruation; pot-belliedness; looseness of the bowels; glandu- 
lar swellings. 

Iodium, second and third stage; fistulous openings, discharging 
a thin, watery ichor, and being surrounded by pale, spongy edges, 
which bleed easily; feverishness; emaciation. After the abuse of 
mercury. 

Kali hydr., doughy, spongy swelling of the knee, without fluc- 
tuation; skin tense at times, red in spots and hot. Inside, a feel- 
ing of heat; gnawing, boring pain at night, necessitating a con- 
stant change of position. After a fall. 

Laches., Lycop., compare the preceding chapter. 

Mercur., after suppressed itch ; nightly pains, etc. 

Pulsat., fever, dryness of tongue, without thirst; diarrhoea; 
scanty and delaying menses. 

Silic, violent, lancinating pains; caries; fistulous openings; 
cachectic condition. 

Sulphur, psoric individuals. Besides, compare Coxarthrocace. 



BURSITIS — PODARTHROCACE. 849 

Bursitis. 

The bursas mucosas are closed sacs, analagous in structure to syn- 
ovial membranes, and secreting a similar synovial fluid. Those 
concerning us now are situated over the patella and the 'inner 
side of the head of the tibia. Being greatly exposed to external 
pressure and irritation, they are subject to inflammations like the 
synovial membrane, constituting an affection known under the 
name of Bursitis, or House-maid's knee, the latter on account of its 
frequent occurrence among female servants, who induce it while 
working in a kneeling position. It is distinguished from syno- 
vitis by its superficial nature and the regularity of its tumefac- 
tion. In acute cases it is attended with severe pain, swelling 
and fever; it may terminate in suppuration, or, when becoming 
chronic, in the formation of a solid tumor. 

THERAPEUTIC HINTS.— Sticta pulm. has been found, by Dr. E. 
C. Price, of great efficacy. 

Arnica and the remedies mentioned in the foregoing chapters 
may likewise need consideration in special cases. 

Silic, in chronic bursitis. 

Podarthrocace, Abscess of the Ankle-joint. 

Commencing with pain, this affection soon shows signs of a 
swelling just in front of each malleolus, filling up the hollow 
which naturally exists there. So also gradually disappear the 
grooves at the side of the tendo Achillis, and the whole joint 
swells considerably. By and by, if suppuration takes place, the 
pus may escape at different places, forming, like in the knee- 
joint disease, fistulous openings, and may lead to considerable 
destruction of the affected bones. 

THERAPEUTIC HINTS.— Compare the preceding chapters. Only 
One remedy, not mentioned there, I must add here, namely: 

Angust. In a case where none of the very carefully-selected 
remedies seemed to have any effect, this remedy at once arrested 
the morbid process and brought it to a perfect cure. In this 
case, the condyles of the tibia were quite seriously involved, and 
it was on account of a remark of Aegidi, "Angustura acts espe- 
cially upon the long bones," that this remedy was given with so 
happy a result. 
54 



850 MOTORY APPARATUS. 

Malum Pottii, Kyphosis, Angular Curvature of the Spine ; 
Spondylarthrocace. 

When the disease has already developed to a visible backward 
curvature of the spine (hunchback), its diagnosis is easy enough, 
only that it comes too late. Of much greater importance are the 
symptoms of the initial stage: the child cries whenever it is taken 
hold of below the ribs, with spasmodic drawing up of the legs, and 
shortness of breath. Besides this there are: periodical pains in the 
epigastric region; listlessness and disinclination to move; disposi- 
tion to lie flat on the stomach or side, only rarely on the back. 
Finally as the disease progresses, one or more spinal processes 
project backward in an acute angle, the head sinks backward 
between the shoulders, and when walking the child props the 
arms on its thighs or knees, instinctively supporting the spine, 
and avoiding all motions which would necessitate a bending of 
the spine. All this is produced by a tubercular affection, or ac- 
cording to other writers, by an inflammatory process of the verte- 
brae, causing the bones to become carious and to crumble away, 
or to form abscesses. Probably both views are correct. The 
tuberculous form seems hardly ever to induce congestive abscesses, 
which are more apt to occur in endosteitis. Both forms no doubt 
grow out of a general contamination of the system, scrofidosis, 
and where this condition exists, an unlucky fall or wrench may 
be sufficient to induce the development of the disease. So also 
it has been observed to often follow after measles, and especially 
whooping-cough. The disease is always of a slow and tedious 
nature. 

THERAPEUTIC HINTS.— As the spinal column gradually loses 
its fitness to sustain the body in an erect position, the horizontal 
position will make itself in many cases necessary ; but too long a 
confinement in bed has other quite serious objections, and it has, 
therefore, been an object of many physicians to invent means by 
which the strain of the spinal column may be relieved. The 
most simple and effectual of these means seem to be Sayre's 
starched bandage, by which chest and abdomen are enveloped in 
fold after fold, until a compact casing of the material surrounds 
the trunk, capable of retaining the bony column in a fixed posi- 
tion. This is done while the patient is suspended by the arm- 
pits, and the head held in an erect position ; the weight of the 



BUNION — INGROWING TOE-NAILS. 851 

body straightens the spine. As soon as the starch is well dried 
and stiffened, the patient is liberated and left to his freedom. 

Calc. carb., or phosph. after Sulphur, when the known scrofulous 
symptoms call for its use. 

Natr. mur., has been recommended by Kafka as a constitutional 
adjuvans to Phosphor. 

Phosphor., main remedy of Kafka. Its symptoms will indicate 
its use in special cases. 

Psorin., proposed by Lilienthal as being fairly indicated by its 
symptoms. 

Silic, indicated by its characteristic action upon inflammatory 
processes of bony structures, and also by the peculiar symptom : 
" sweating of the head only." 

Sulphur, is according to Jahr the remedy to commence with, if 
indicated by the general condition of the patient. 

If excited by external injury: Aeon., Arnica, Hyper., Rhus 
tox. 

Other remedies recommended: Angust, Arsen., Asaf., Aurum, 
Bellad., Calc. jod., Hepar, Lycop., Mercur., Mezer., Phosph. ac, 
Plumbum, Pulsat. 

Compare also Rachitis and the foregoing chapters. 

Bunion. 

"What bursitis is to the knee, bunion is to the metatarsal joint 
of the great toe, an inflammation of the bursas situated in this 
joint, in consequence of undue pressure of shoes or boots. 

Arnica often relieves the acute symptoms, and Calc. carb. fre- 
quently cures chronic cases. 

Ingrowing Toe-nails. 

Compare: Colchic, Graphit., Kali carb., Magnet, austr., Mar. 
ver., Natr. mur., Phosphor., Silic. 

Perch loride of Iron has been used externally to dry the in- 
flamed parts. (Wahle.) 



NERVES. 

The anatomical diseases of the peripheral nerves comprise : 

1. Neuritis, Inflammation of the Nerves. 

This may be acute or chronic. The acute form, usuallj* brought 
on by external injuries, or neighboring destructive processes 
(sloughing, cancer), begins with chilliness, or an actual rigor, 
being followed by fever, headache and sleeplessness, and is at- 
tended by severe pain, starting and extending from the injured 
spot over the region to which the nerve is distributed. In some 
cases a red line in the skin indicates the course of the inflamed 
nerve, and the skin-surface of its distribution exhibits a marked 
degree of hyperesthesia with the subjective sensation of numbness 
and formication. 

The chronic form is characterized by pain and paraesthesia in 
the area of distribution of a certain nerve, by motor and sensory 
irritation with subsequent paralysis, by painful swelling of the 
nerve. 

The most important remedy for neuritis in consequence of ex- 
ternal injury is Hyper, perf. (Hering.) 

2. Atrophy of the Nerves 

Is most frequently the consequence of inflammation, compression 
or central disease, and can only be reached so far as the original 
disease is amenable to treatment. 

3. Hypertrophy and Neoplastic Formations in the Nerves. 

Hypertrophy of peripheral nerves, that is an increase of the nerve- 
fibres in number, great thickness of the medullary sheath and 



HYPERESTHESIA, ANAESTHESIA. 853 

even of the axis cylinder, or oftener an interstitial hypertrophy 
of the connective tissue, is of a mere anatomico-pathological, but 
of no clinical interest. 

Neoplastic formations in the nerves, also called neuromata, are 
made up either of true nerve-tissue (Neuromata vera), or are com- 
posed of any other tissue, giving rise to Fibromata, Myxoniata, 
Sarcomata, Carcinomata, Syphilitic gummata, Lepra nervorum, 
all known under the general name Neuromata spuria. 

Their Etiology is obscure, and "an exact anatomical diag- 
nosis can be accomplished with certainty only by means of the 
microscope. When no tumors can be demonstrated by external 
examination, their presence can be concluded only with some 
probability from the existing nervous disturbance." (Erb.) 

The functional diseases of the peripheral nerves comprise: 

1. Hyperesthesia, Anaesthesia. 

By means of the sensory nerves we receive external impres- 
sions. Light affects the optic, sound the auditory, perfume the 
olfactory, sapid substances the gustatory nerves, palpable things 
the nerves of touch, and heat, cold, etc., the nerves of general 
feeling. 

These nerves are so constituted that they bear external in- 
fluences to a certain extent with perfect ease, although we find 
in even healthy individuals a great difference in this respect. 
Some perceive the slightest, others only more powerful influ- 
ences ; but, as a general rule, the ordinary influences of the outer 
world are borne by all with equal ease. 

In this disease, however, it is often different. "We observe that 
ordinary light, the slightest noise, the least touch, etc., are un- 
bearable. This condition is called morbid sensitiveness. It is fre- 
quently in combination with a state of fidgetiness and restless- 
ness, and then it is called nervousness. 

Post-mortem examinations do not reveal the least alterations 
of the nerves, and its seat may just as well be referred to the 
primary faculties of the mind, of which the corresponding nerves 
are merely the bodily organs, by which the mind lies open to ex- 
ternal influences. 

Anaesthesia of the sensory nerves is the opposite to morbid sen- 
sitiveness — a want of natural sensibility; to which we might add 
numbness, pithiness, either in consequence of pressure upon a nerve, 



854 NERVES. 

or in consequence of central disturbances, by which its normal 
action is interfered with. 

THERAPEUTIC HINTS.— Compare Boenninghausen's Repertory. 

Sensitiveness to light, (principally) Aeon., Arsen., Bellad., 
Euphras., Mercur., Rhus tox., Sulphur. 

Sensitiveness to noise, Aurum, Coffea, Lycop., Sepia, Spigel. 

Sensitiveness to smell, Aurum, Bellad., Lycop., Mercur., Phos- 
phor., Sepia. 

Sensitiveness to taste, Bellad., China, Coffea. 

Sensitiveness to touch, Arnica, Bellad., Coffea, Hepar, Lycop., 
Nux vom., Pulsat., Sepia, Spigel. 

Nervous debility, China, Coccul., Nux vom., Phosphor., Pulsat., 
Silic. 

Fidgety disposition, Anac, Bellad., Hyosc, Mercur., Rhus tox., 
Sepia, Staphis., Stramon., Zincum. 

Pithy, numb feeling, Coccul., Hyosc, Lycop., Oleand., Opium, 
Phosph. ac, Stramon. 

2. Neuralgia. 

Neuralgia literally means a pain of the nerves. In this sense 
of the word, any and every pain would be a neuralgia ; because 
there is no pain possible without sensitive nerves. 

This is not the sense in which the term neuralgia is used. 

Hasse defines it in the following language : " Neuralgia char- 
acterizes itself physiologically as an irritation in the course of 
one or several sensory nerves, which irritation may exist on any 
part of the nerve, from its origin down to its termination, and 
which irritation is felt as pain; not, however, only in the place 
where the irritation exists, but also in different other places of 
the same nerve; sometimes even through its whole length." 
Such irritation and consequent pain may be occasioned by the 
most different causes, so that neuralgia may be a symptom of 
very different conditions. Structural changes of the nerves them- 
selves, however, are very rarely found, and then only in paralytic 
conditions. Those coarser structural changes which we have 
called tumors of the nerves, or neuroma, may exist without any 
neuralgia ; and the most violent neuralgia may not show a trace 
of structural change on post-mortem examination. "We cannot, 
therefore, so clearly define neuralgia pathologically as other forms 



CEPHALALGIA. 855 

of disease ; as, indeed, it is only a symptom of the most different 
conditions. 

Such conditions are either peripheral or central. 

1. Peripheral Causes are either organic changes of the nerves 
themselves — most frequently in consequence of external injuries 
— or organic changes in neighboring parts of the nerves, as in- 
flammation, caries, and exostoses of the bones, especially in the 
neighborhood of the foramina, through which the nerves make 
their exit ; also tumors — especially carcinoma and aneurisma — 
and affections of the liver, uterus, ovaries, kidneys, etc. 

2. Central Causes are structural changes in the brain and 
spinal cord, and their membranes, consisting of tumors, softening, 
sclerosis, and deposits of morbid products. Besides these causes 
we may also mention exposure to cold, metallic poisoning — espe- 
cially by mercury and lead — and miasmatic influences, which 
latter cause a periodical type, like intermittents. 

Symptoms. — 1. Pain. It is of various kinds: boring, cutting, 
tearing, burning, like lightning, but always described as excru- 
ciating. It generally comes in paroxysms, and is felt in many 
cases distinctly running along the course of a certain nerve. It 
is often provoked or aggravated by softly touching or stroking 
the parts, whilst hard pressure frequently relieves it. 

2. Concomitant symptoms. They consist of affections of the 
motory nerves, causing spasmodic motions in those parts in 
which the affected sensory nerve branches out, prosopalgia and 
almost always distortions of the face ; of affections of the vaso- 
motor}/ nerves, which manifest themselves in paleness of the skin 
and chilly sensations, followed by heat and turgor, sometimes by 
profuse perspiration or profuse secretion or scantiness of urine; 
of affections of the trophic nerves, causing change of color in the 
hair, falling off of the hair, or thickening or atrophy of various 
tissues, or a disposition of the skin to various inflammatory pro- 
cesses, such as erythema, erysipelas, pemphigus, urticaria and 
zona. 

The most important special forms of neuralgia are : 

1. Cephalalgia; Hemicrania or Migrsena, or Nervous 
Sick Headache. 

Cephalalgia or headache, or pain in the nerves of the head, may 
be attendant upon the most various morbid conditions of the 



856 NERVES. 

body, to which some persons are more liable than others. We 
have headache from anaemia and from active hyperemia, also 
toxic, hysterical, rheumatic and sympathetic headaches. 

Hemicrania or Migrsena, or nervous sick headache on the other 
hand is a peculiar form of half-sided headache, which, by some, 
has been considered as a neuralgia of the temporal, frontal and 
occipital nerves, or as a hyperaesthesia of the brain, or a cerebral 
neuralgia, or as a hysterical manifestation of some derangement 
of the menstrual function, while Du Bois Raymond took it for a 
neurosis of the vasomotor nerves, consisting of spasms of the 
vascular muscles of the affected side, causing paleness and con- 
traction of the features and dilatation of the pupils, and Moellen- 
dorf considered it as a paralysis of the vascular muscles, which 
manifests itself in dilatation of the central retinal and choroidal 
vessels of the affected side, in a slower pulsation of the heart, in 
a soft and large pulsation of the carotids and temporals, and in 
cold hands and feet, Both agree in this that hemicrania be due 
to alterations in the cerebral circulation, in the one case produced 
by spasm and in the other by parabysis, of the vascular muscles, 
both induced by a disturbance of the sympathetic nerve either 
in its cranial or cervical portion. 

This complaint, which is so frequently met with, returns 
periodically. It generally commences in the morning, in- 
creases during the course of the day as the sun ascends, and 
reaches its culmination in the evening; very often it attacks 
only one side of the head, or passes from one side to the other, or 
is confined to the top of the head, or to the forehead or occiput. 
It often reaches an almost unbearable pitch, is associated with 
nausea, and generally ends with gagging and vomiting of bitter, 
greenish, or slimy masses. In some cases one thorough vomit- 
ing is sufficient to relieve the pain, while in others both retch- 
ing and pain continue for several hours, until, finally, a sound 
sleep relieves it all. During the paroxysm the patient is very 
sensitive to light, noise, strong smells, and touch ; he seeks a 
dark, quiet place where he can lie undisturbed. 

Migrsena is most frequently met with in women of a hysteric, 
ehlorotic, or anaemic tendency, and a weak and nervous constitu- 
tion, also in married women who have no children, and in 
young widows. Men of weak constitution, who read and study 
much in the night, or who lead a loose life, are likewise subject 
to migrsena. In all, it seems that the habitual use of coffee and 
tea has a great deal to do with its periodical recurrence. 



CEPHALALGIA. 857 

THERAPEUTIC HINTS.— Aeon., in full-blooded individuals; rush 
of blood to the head ; tbe pain is centered in glabella, excruciat- 
ing, driving to despair. 

Aethusa cyn., pressing pain in the forehead, as though it would 
split ; or a* if there were a tight hoop around the head ; eyes ap- 
pear protruded and the face is pale ; great anxiety and restless- 
ness drives into the open air, which relieves. At its height, 
vomiting, belching ; hiccoughing ; finally diarrhoeic stool ; some 
hours sleep and pain in the stomach for several days. 

Agar., pressing pain in right temple, as if a nail were thrust in, 
worse sitting, better moving about slowly ; dull, drawing head- 
ache, worse in morning, extending into root of nose, with nose- 
bleed or thick mucous discharge ; headache from overwork at 
desk. 

Amyl. nitr., hemicrania, worse on left side; the affected side 
looks pale in comparison with the sound one. 

Ant. crud., headache after bathing in the river, from deranged 
stomach by alcoholic drinks ; thick, white coating on tongue. 

Aranea diad., when the spells come at regular hours ; flimmer- 
ing before the eyes; dizziness in the head, which obliges the 
patient to lie down ; on rising a feeling as though the head and 
hands were bloated and swollen. 

Arg. nitr., pressive pain in the forehead on getting awake in the 
morning, gradually extending from the supraorbital ridge up- 
wards to the coronal suture, with heaviness in the head and ver- 
tigo, which does not turn in a circle, but inclines the patient to 
reel to the one or the other side ; dimness before the eyes ; ring- 
ing in the ears ; sense of relaxation in the stomach, as though it 
were hanging down loosely; all the symptoms better after eating 
a good dinner and drinking a glass of wine ; worse after drink- 
ing coffee; or the pain is half-sided in one of the frontal protuber- 
ances, or close to the side of the glabella near the supraorbital 
ridge, or in one of the temples, sometimes extending down into 
the bones of the face; the pain is of a pressive, screwing, throb- 
bing nature, and is always preceded by general indisposition ; 
chilliness; loss of appetite; growing dim before the eyes, and 
nausea. At its height it is attended with trembling of the whole 
body and a deadly nausea, which ends with vomiting. 

Arnica, periodical spells, commencing slightly in the morning 
in the forehead, with flickering before the eyes, which is aggra- 
vated by reading or writing, gradually extending through the 



858 NERVES. 

temples into the occiput, and reaching its acme in the afternoon. 
A warm room is unbearable, but the open air does not amelior- 
ate ; must lie perfectly quiet, stretched out upon his back ; worse 
from any motion, quick walking, bending, going up stairs, talk- 
ing, thinking, and after eating. 

Arsen., hemicrania in persons with affections of the liver; alter- 
nating bilious colic and migraena ; great sensitiveness of the head 
to the open air; during the spells the patient is very restless, 
constantly moves the head and limbs to and fro, and imagines 
that he gets some relief from so doing; better from external 
warmth ; from wrapping the head up in warm cloths ; he feels 
extremely prostrated ; thinks he must die ; feels chilly and 
hovers near the stove. 

Bellad., one-sided pain, especially on the right side; throbbing, 
beating, attended with vertigo, congestion of the head and eyes, 
and throbbing of the carotid arteries; or great paleness of the 
face ; pain worse on lying down, better on bending head back- 
ward, and external pressure. 

Bryon., headache on first waking in the morning, gradually in- 
creasing until evening; pain as though the forehead would burst; 
worse from any motion, coughing, or sneezing. Tongue thickly 
coated ; violent thirst or only dry feeling in the mouth ; gastric 
derangement ; constipation or diarrhoea in the morning ; the pa- 
tient is very irritable and cross; gets angry easily. 

Cact. grand., pain in rigid temple by spells, brought on often by 
a glass of wine, by attending the opera, after getting his dinner 
at too late an hour ; it commences in the morning and increases as 
the day advances to an awful height, with vomiting. He must 
lie perfectly quiet; any attempt to keep up, any noise, light or 
exertion, increases the suffering terribly ; constant dry nose. 

Calc. carb., chronic cases ; after days before or after the menses 
which are profuse, pain centering in top, as if she should go 
crazy; after suppressed eruptions; strange feeling of coldness in 
some part of the head, or in the whole head; pain worse from 
early in the morning after getting awake until afternoon; cold, 
sweaty hands and feet. 

Calc. phosph., headache of children from going to school ; from 
change of weather with other rheumatic pains, especially about 
sutures and symphyses. 

Camphora, throbbing pain like a hammer in the cerebellum, 
synchronous with the beats of the heart; after sunstroke. 



CEPHALALGIA. 859 

Chamom., commences with nickering and fiery zigzags before 
the eyes so that one cannot see or read, followed by terrible head- 
ache. 

China, the pain is increased from slight touch, from opening 
the eyes, or from keeping them shut; sometimes the pain is re- 
lieved by lying down, at other times the patient cannot lie down ; 
better while moving about gently, or sitting up erect. Nursing 
females after loss of vital fluids. 

Chin, sulph., intermittent neuralgia at regular hours. 

Coccul., the pain is worse after eating, drinking or smoking and 
attended with a sense of emptiness and hollowness of the head. 

Coffea, when the pain drives to despair and the patient runs 
wildly about the room. 

Coloc, pain, tearing, and screwing together; great restlessness 
and anxiety, with sweat, which smells like urine; urine scanty 
and fetid ; after chagrin and indignation. 

Ferrum, congestion of the brain; throbbing; crimson face, which, 
at other times is quite pale and earthy-looking. The pain drives 
one out of bed. 

Gelsem., commences with dimness of sight and double vision; 
vertigo ; heaviness or lightness of head ; wild feeling, alternating 
with uterine pains; worse about 10 a.m., and when lying down; 
better from shaking head, from sitting and reclining the head on 
a high pillow, from profuse emission of urine. 

Glonoin., congestion of the brain ; throbbing, pulsating pain from 
below upwards, with fulness and feeling of enlargement of the 
head ; it feels like the motion of waves in the brain ; congestion 
of the eyes ; ringing in the ears ; palpitation of the heart. During 
pregnancy, before the menses, or when the menses do not appear; 
from heat of sun. 

Hepar, headache over the eyes pressing down upon the eyes; 
covers tightly even when hot and perspiring. 

Ignat, throbbing pain in the occiput, worse from pressing at 
stool; from smoking, from the smell of tobacco-smoke; for ner- 
vous subjects who get frightened easily, feel hurt easily, etc.; 
intermittent from 9 a.m. to 2 p.m., worse from washing hands in 
cold water, bending head forward, stepping heavily; better from 
soft pressure, lying on back, and heat. 

Iris vers., beginning with a blur before the eyes ; of hepatic or 
gastric origin, with nausea and vomiting ; mostly on right side, 
or changing sides in different attacks. 



860 NERVES. 

Lach.es., temporal nerves of one side painful, with throbbing in 
the temples; heat in the head; vertigo with paleness of the face; 
pain in the left ovarian region; bloatedness of the stomach; 
frontal headache after suppressed coryza. 

Lil. tigr., terrible, tearing, crazy pain running from back up 
into top of head, with a feeling as if she would lose her reason, or 
would lose her soul when dying. Squeezing feeling about the 
heart. 

Melilot, congestive headache, better from bleeding of nose. 

Menyan., pressing pain in forehead and temples from above 
downwards, relieved by firm pressure with the hand. 

Natr. mur., commencing in the morning when getting awake ; 
it gets worse from reading, writing, and talking; and is frequently 
indicated when school-girls, who apply themselves closely to their 
lessons, get a severe headache. 

Nux vom., pressive, boring, dull pain, mostly over left eye, com- 
mencing in the morning, increasing through the day, growing 
milder in the evening, attended with dimness of sight, stoppage 
of the nose, sour and bitter vomiting ; constipation ; palpitation 
of the heart ; worse from mental exertion, light and noise, in the 
open air, after eating; brought on by masturbation, hysteria, 
with profuse menses, sedentary life, close mental application, 
abuse of coffee, with hajmorrhoidal disposition, constipation, dis- 
turbances in the ganglionic system. 

Phosphor., intense pain in eyes and whole head, worse in left 
eye, in forenoon, or from stooping, better while eating, lying 
down, and after sleeping. 

Phosph. ac, dreadful pain on the top of the head, as though the 
brain were crushed, after long-continued grief. 

Platina, cramping pain, as though the part were in a vice. 
especially above the root of the nose, with heat and redness of 
the face, tearful disposition, and too early and profuse men- 
struation. 

Pulsat, tearing, pressing, stitching pain, mostly on right side 
of head, worse in the evening and at night, in the warm room, 
better from external pressure and in the open air, with aversion 
to eating and drinking ; water tastes bitter : nausea : vomiting ; 
oppression of the chest, and chilliness; mild, yielding disposi- 
tion ; scanty, delayed menses ; disposition to looseness of the 
bowels. 

Rhus rad., commencing; in the back of neck, the muscles are 






CEPHALALGIA. 8G1 

sore to touch, it spreads up and over entire head; worse in rest 
and cold, better on moving and warmth ; brought on by cold 
draught on back and neck, and cold, damp and rainy weather. 

Sanguin., the pain commences in the back part of the head, 
rises and spreads over the head, and settles especially above the 
right eye, with nausea, vomiting, and chilliness ; the patient is 
obliged to seek a dark room and to lie perfectly still ; flushes of 
heat ; burning of the soles of the feet ; scanty urine at first, later 
profuse flow of clear urine. 

Sepia, the pain is jerking upwards, like an electric shock, or 
boring ; worse from motion, better from holding the eyes shut ; 
pale, yellowish, dirty color of the face ; white tongue ; aversion 
to food ; sour taste after eating ; constipation ; obstruction of the 
portal system ; leucorrhcea between the menses ; irregular men- 
ses ; bearing down of the womb. 

Silic, pressing, throbbing pain in the occiput upwards, also 
from occiput to eyeballs, especially the right one, worse from 
every quick exertion, pressing to stool, etc., better from getting 
warm, and after sleep ; the pain is attended with a peculiar ex- 
aggeration of the mind; when crossed, he has to restrain himself 
from doing violence ; appetite good ; while eating the pain is 
much milder, but grows so much the worse again afterwards ; 
brought on by exposure of the back to any slight draught ; bet- 
ter from wrapping the head up warmly. 

Spigel., different sorts of pains, frequently extending into the 
eye and side of the face, always worse from stooping, slightest 
motion, concussion, noise, and during stool ; they are apt to ap- 
pear at regular hours, either in the forenoon or in the night, and 
are mostly attended with paleness of the face, palpitation of the 
heart, and oppression of chest. 

Sulphur, pain in the forehead and top of the head ; heat in the 
head and coldness of the feet ; flying heat in the face ; nightly 
sleeplessness ; itching of the skin ; suppressed eruptions ; loose- 
ness of the bowels early in the morning, driving out of bed ; 
haemorrhoids, etc. 

Thuja, hemicrania of sycotic origin, mostly worse soon after 
midnight. 

Veratr., pain very violent, driving one to despair; or prostrat- 
ing, causing fainting; cold sweat and great thirst; great nausea, 
vomiting and diarrhoea, or obstinate constipation. 

Zincum, in chronic cases of cerebral affections; great weakness 



862 NERVES. 

of sight; stitching pain in the right eye; paleness of face; now 
and then vomiting ; fidgetiness of the legs. 

2. Neuralgia of the Trigeminus or Fifth Nerve, Proso- 
palgia, Neuralgia Facialis, Dolor Faciei Fothergillii, 
Tic douleureux. 

It attacks one or the other branch of the trigeminus, sometimes 
the n. supra-orbitalis or infra-orbitalis, n. facialis, n. infra-maxilla- 
ris, and, therefore, some authors speak of a neuralgia supra- 
orbitalis, neuralgia infra-orbitalis, etc. The affection is almost 
always confined to one side ; rarely does it attack both sides, but 
there appears to be no difference in favor of one or the other side. 
An extension from one side to the other has been occasionally 
observed. 

The pain is generally spoken of by the patient as indescribable, 
excruciating, coming on in paroxysms of shorter or longer dura- 
tion, sometimes irradiating into the back part of the head and 
neck, down into the shoulder, intercostal spaces, breast and even 
the lower extremities. 

We likewise find the motory nerves affected, causing jerking of 
different muscles of the face, spasmodic closing of the eyelids, 
bending of the body double, trembling of the whole body, etc. 
We also find the vasomotory nerves affected, causing pulsation 
of the arteries, swelling of the veins, redness, or paleness, and 
heat of the face. The whole affected side of the face assumes a 
different expression, becomes shining, glistening, greasy, some- 
times appearing puffed and at other times emaciated. 

When the ramus ophthalmicus is affected, we observe a redden- 
ing of the conjunctiva and flowing of tears ; if, at the same time, 
the second branch is also affected, we observe a watery and slimy 
discharge from the nose ; and when the second and third branches 
suffer, it is often attended with a flow of saliva. 

Sometimes there has been observed a partial sweat in the face 
during the paroxysm ; the hair of the affected side grows brittle 
and splits, or falls out. 

THERAPEUTIC HINTS.— Aeon., cheeks red and hot ; the patient 
seems beside himself for pain, screams and rolls about in the 
bed or on the floor. 

Arg. nitr., during the paroxysms, unpleasant, sour taste in the 



NEURALGIA. 863 

mouth. Wolf mentions Arg. nitr. as of general importance in 
this complaint. 

Arsen., burning, stinging pain, as of red-hot needles, worse 
about midnight ; face pale and distorted ; puffed around the eyes; 
great restlessness ; ameliorated by external warmth ; typic par- 
oxysms of a miasmatic origin. 

Bellad., cutting, tearing pain, shooting from the side of tbe face 
up into the temple, into the ear, and down into the nape of the 
neck ; worse from touch and motion ; hard pressure sometimes 
relieves ; the paroxysms mostly occur in the afternoon ; the face 
is generally flushed ; the eyes water and the muscles of the face 
twitch ; the patient cannot bear light nor noise ; the right side is 
the most frequently affected; after the abuse of mercury. 

Bismuth nitr., the most excruciating pains are somewhat re- 
lieved by taking cold water in the mouth and walking briskly 
about. 

Calc. carb., pain from right mental foramen along lower jaw to 
ear, attended with frequent urination; worse from cold air; bet- 
ter from warm air and warm applications. 

Caustic, right side, from the cheek-bone to the mastoid process, 
worse at night ; better from rubbing with a cloth dipped in cold 
water ; chilliness ; scanty menses. 

Chamom., the pain causes hot perspiration about the head, and 
extorts screams ; the patient is wild and unruly, tossing and roll- 
ing about ; menses usually profuse. 

China, the pain is in the infra-orbital and maxillary nerves, 
worse from the least touch, lying down, and in the night ; great 
weakness after the paroxysm. 

Chin, sulph., the paroxysms set in at the same hour every day; 
the intervals are free of pain, and there is no complication with 
gastric or other derangements. 

Cimicif., especially when the neuralgia is a reflex-pain depend- 
ent upon ovarian disturbances. 

Coloc, tensive tearing with heat and swelling, especially left 
side, also right side ; motion and touch increase the pain ; better 
in perfect rest, and from external application of warmth ; brought 
on by chagrin and indignation. 

Ferrum, during the paroxysms the face gets fiery red, sometimes 
only in one spot ; cannot keep the head quiet ; at the intervals 
the face looks earthy and pale. 

Gelsem., orbital neuralgia in distinct paroxysms of acute pain, 



864 NERVES. 

accompanied with contractions and twitching of the muscles near 
the portion of the face affected; with extreme general nervous- 
ness and loss of control over the voluntary muscles, giving rise 
to odd, irregular motions. 

Hepar, in chronic cases; the pain streaks from the cheek-bone 
into the temple, ear, alse nasi, and upper lip of the affected side; 
it is worse in the fresh air, and better from wrapping up the face; 
at the same time coryza, hoarseness, much sweating and rheu- 
matic pains elsewhere; especially after the abuse of mercury or 
metallic preparations. 

Iris, pain in the head, temples and eyes, attended with most 
distressing vomiting of a sweetish mucus, and occasionally (if 
attended by much straining) of some bile. 

Laches., left side, orbital neuralgia; lachrymation ; previous to 
the paroxysm rising of heat to the head ; during the intervals a 
weak, nauseous feeling in the abdomen. AVaking out of sleep the 
eyes feel as though they had been taken out and scpieezed. and 
then put back again ; malarial affections. 

Magn. carb., left or right side; shooting like lightning; worse 
from touch, draught, change of temperature; cannot stay in bed, 
must walk the floor. 

Magn. phosph., supra-orbital and infra-orbital nerves pain at in- 
tervals and relieved by external warmth. 

Mercur., tearing pains, worse at night in bed; it often starts 
from a decayed tooth and involves the whole side of the face, 
which may be red and swollen ; profuse secretion of saliva ; con- 
stant inclination to perspire; restlessness and sleeplessness. 
Brought on by taking cold. 

Mezer., ciliary neuralgia, especially after operations on the eye ; 
prosopalgia, left-sided, from over the eye to the eyeball, check. 
teeth, neck and shoulder; lachrymation; conjunctiva injected; 
parts sensitive to touch; worse from warmth; periodical from 
9 a.m., increasing to 12 m., and decreasing gradual^ until 4 p.m., 
leaving the patient perfectly free from pain. Also boring, press- 
ive pains, coming like lightning, which leave the parts numb; 
they are worse from eating warm food, also from entering a 
warm room after walking in the fresh air; they are attended 
with chilliness and shuddering; twitching of the muscles of the 
affected parts, flow of saliva, redness of the fauces, burning in the 
throat, stiffness of the masseters, red spots on the nape of the 
neck, and formication in the skin of the chest; after the abuse of 
mercury, or in syphilitic patients. 



NEURALGIA OF FACE. Obo 

Natr. mur., pain in the malar bones, worse when chewing; fall- 
ing off of the whiskers; intermittent prosopalgia; after the abuse 
of quinine. 

Nux vom., tearing pain in the course of the infra-orbital and 
middle branch of the trigeminus, with redness and watering of 
the eye; flow of clear water from the nostrils, and numbness of 
the affected side; the patient is morose, irritated, belches a great 
deal and is constipated ; after the abuse of coffee, liquors, quinine, 
etc.; also intermittent prosopalgia; worse from noise, motion, cold 
air ; better in a warm room, at rest and lying down. 

Phosphor., drawing and tearing pain in the jaws, root of the 
nose, eyes and temples, attended with bloatedness of the face, 
congestion of the head, tearing on the top of the head, vertigo, 
and ringing in the ears ; from taking cold over the wash-tub. 

Platiiia, boring pain, cramp-like ; painful feeling of numbness 
in the malar bones and the mastoid processes and chin, as if the 
parts were between screws, attended with anxiety, weeping, and 
palpitation of the heart ; profuse menses. 

Pulsat, twitching, tearing pain, worse in the evening and in a 
warm room ; in persons of a mild, tearful disposition, and phleg- 
matic temperament; inclination to looseness of the bowels; scanty 
menses ; after getting the feet wet ; after the abuse of quinine. 

Rhodod., right side ; by wind and changes of weather, better 
from warmth, and relieved while eating and for some time after. 

Rhus tox., drawing, burning, tearing pain in the face, and a 
feeling as though the teeth were too long, attended with great 
restlessness, necessity to move about ; relieved somewhat by the 
external application of cold ; dysenteric stools, with jelly-like 
evacuations ; after exposure to rain. 

Sanguiii., in upper jaw extending to nose, eye, ear, neck and 
side of head ; shooting, burning pains ; kneel down and hold 
head tightly to the floor. (Hering.) 

Sepia, intermittent prosopalgia, with congestion of eyes and 
head ; also during pregnancy ; jerking, like electric shocks, 
upwards. 

Spigel., tearing, shooting, jerking or burning pain in all direc- 
tions, suddenly coming and going, attended with dark redness of 
the affected side ; flow of water from the eyes and nose ; twitch- 
ing of the muscles in the face ; difficulty of breathing ; palpita- 
tion of the heart; rheumatic pains elsewhere; worse in damp 
weather, from touch and motion ; after suppressed intermittents. 



866 NERVES. 

Stannum, intermittent supra-orbital neuralgia from 10 a.m. to 3 
or 4 p.m., gradually increasing until attaining its acme, and then 
again decreasing as gradually ; after abuse of quinine. 

Staphis., the pain starts from a decayed tooth; is worse from 
slight and better from heavy pressure ; it is attended with swell- 
ing of the gums, cold sweat in the face, and cold hands. 

Stramon., prosopalgia, with many nervous symptoms: spasms 
of the chest hindering breathing; swooning; weeping; twitching 
of the muscles of the face; frowning; jerks through the whole 
body ; delirious talk, with open eyes. 

Sulphur, intermittent periodic neuralgia every twenty-four hours, 
worse generally at 12 m. or 12 p.m., or midsummer or midwinter; 
chronic cases, when other remedies relieve, but do not cure; 
psoric tendency ; scanty, black, tarry menstrual discharges. 

Thuja, after suppressed gonorrhoea or eczema on the ear. 

Veratr., drawing, tearing pain, attended with bluish paleness of 
the face ; sunken eyes ; coldness of the extremities ; trembling 
and jerking; cold perspiration; great exhaustion; nausea and 
vomiting. 

Verbasc, violent pain, jerking, like lightning, or pressive, 
numbing; aggravated by pressure, sneezing, talking, chewing 
or a draught of air; appears at the same hour every day, 11 a.m. 
till 4 p.m., and is attended with headache, redness of the face, 
vertigo, belching, and a discharge of tough saliva from the 
mouth. 

Zincum, burning, quick stitches, and jerking along the course 
of the infra-orbital nerve, right side, attended with bluish eye- 
lids; numbness of the tongue ; constricted sensation of the throat; 
worse from the slightest touch and in the evening. 

3. Cervico-Occipital Neuralgia. 

Its seat is in the region of distribution of the sensory fibres of 
the upper four spinal nerves, most frequently only on one side, 
extending, therefore, over the upper part of the nape of the neck 
and the occiput, over the lateral region of the head, and in front 
towards the lower jaw. The occipitalis major frequently shows 
painful sjwts, one about half way between the mastoid process 
and the upper cervical spinous processes (occijiital point), and the 
parietal point over the parietal eminence. Of the other nerves im- 
plicated such points can rarely be demonstrated. 



CERVICO-BRACHIAL NEURALGIA. 867 

Compare Aeon., Bellad., Calc. carb., Caustic., Ignat., Kalmia 
lat., Laches., Nux vom., Pulsat., Rhus tox., Spigel., Sulphur. 

4. Cervico-Brachial Neuralgia 

Extends over the region of distribution of the four lower cervical 
nerves and a part of the first dorsal nerve, and may affect the 
back of the neck, the upper, or the lower arm, even the hand 
and fingers. The painful points are numerous, but somewhat in- 
definite ; they may be found : " over the brachial plexus from 
the axilla outwards ; at the lower angle of the scapula ; on the 
posterior surface of the shoulder ; on the median at the elbow ; 
at the emergence of the cutaneous medius and lateralis from the 
fascia of the forearm ; on the ulnar above the internal condyle, 
and at the wrist ; on the radial nerve where it winds around the 
humerus, and above the wrist, on the spinous processes of the 
four lower cervical, and two or three upper dorsal vertebrae, and 
at their sides where the posterior branches appear under the 
skin." (Erb.) 

Compare Aeon., Arnica, Arsen., China, Ferrum, Graphit., Ignat., 
Lycop., Phosphor., Rhus tox., Sepia, Staphis, Sulphur, Veratr. 

5. Intercostal Neuralgia 

Has its seat in the region of distribution of the dorsal nerves, 
and not unfrequently affects both sides of the chest, but most 
frequently the left side only between the fifth and ninth inter- 
costal spaces. There is a feeling of tension, as though the patient 
were tightly bound around the chest, and occasional shooting 
pains in the direction of the intercostal nerves are occasioned by 
taking a long breath, by coughing, sneezing, sighing, or certain 
motions of the body ; by pressure of the clothing or a slight 
touch, which generally is relieved again by hard pressure. 

The painful points are in the region near the spinous process of 
the vertebrae, where the dorsal nerves emerge from the spine 
(vertebral point) ; in the middle portion of these nerves, where 
the ramus perforans lateralis emerges beneath the skin (lateral 
point) ; in the region close to the sternum, and in the abdomen 
over the rectus muscle (sternal and anterior point). 

Differential Diagnosis. — Pleurisy differs by its rubbing- 
sound and fever, 



868 NERVES. 

Angina pectoris by its fits of suffocation, 

Rheumatism of the muscles of the chest by its more general diffu- 
sion over the chest and its aggravation by slightest movement. 

Compare Arnica, Arsen., Borax, Bryon., Calc. carb., Carb. veg., 
Caustic, China, Cimic, Mercur., Rhus tox., Sepia, Spigel., Sulphur. 

After shingles : Mezer., Secale corn. 

6. Lumbo-Abdominal Neuralgia 

Has its seat in the region of distribution of the lumbar nerves, 
and consists of pain in the lumbar region and on the abdomen, 
which is easily excited by raising a fold of the abdominal skin, 
or by touching it slightly, and by pressure upon the region near 
the lumbar vertebrae. Frequently we find associated with it a 
pain in different places of the crest of the ileum and on the seat; 
and also pain which extends from the inguinal region to the 
symphysis pubis and down into the scrotum or into the labia 
majora, which are referable to the superficial branches of the 
lumbar nerves. 

Its painful points are: "one or several in the lumbar region 
near the spinal column (lumbar point) ; one about the middle of 
the cresta ilii (iliac point) ; one or several above the symphysis 
pubis, at the side of the linea alba (abdominal point); not un- 
frequently one in the scrotum or labium majus; and lastly, and 
less constantly, one in the inguinal .region or in the portio vagi- 
nalis uteri, or in the corresponding side of the vault of the 
vagina." (Erb.) 

Compare Argent., Bellad., China, Kalmia lat., Xux vom., 
Pulsat, Rhus tox., Spigel., Staphis., Sulphur. 

7. Mastodynia, Neuralgia of the Mamma?. 

Its seat is in the mammary glands, which are supplied chiefly 
from branches of the intercostal nerves. The breast becomes very 
painful, often without any visible change in its structure. In 
some cases, however, small tumors (neuromata) have been ob- 
served, which appear to be the starting-points of the neuralgia, 
and they either disappear soon or remain unaltered for years. 
The pain radiates sometimes into the axillae, into the back and 
down into the hips, and may be attended with vomiting. Lying 
on the affected side is impossible. Painful points may be found 



SCIATICA. 8G9 

on the nipples or on the sides of the breast, or on the spinous 
processes of the second, third, fourth, fifth and sixth dorsal ver- 
tebrae. Mastodvnia seems mostly connected with irregularities of 
menstruation, at which time it is generally the worst. But also 
lactation, external injury, anaemia, chlorosis and hysteria are 
counted among its causes. Its most frequent occurrence seems to 
be between the ages of sixteen and thirty. 

THERAPEUTIC HINTS.— Painfulness of the mammae before or 
during menstruation, Argent., Calad., Calc. carb., Canthar., Cimicif., 
Conium, Kali carb., Murex purp., Xitr. ac, Rhus tox., Tabac. 

During the nursing of the child: Crot. tigl., Ferrum, Phell. 
aquat., Phosphor., Silic. 

8. Neuralgia ischiadica, Sciatica, Ischias postica, Malum 
Cotunnii. 

Its seat is in the n. ischiadicus, though not always in its entire 
length. Most frequently we find the pain extending from the 
nates down the posterior part of the thigh to the bend of the 
knee, down along the fibula to the external ankle, heel and ex- 
ternal portion of the foot; the internal border of the foot is 
exempt; sometimes the pain is felt only in the sole of the foot 
(neuralgia plantaris), and seldom in the dorsum of the foot and 
toes. In rare cases both extremities are affected at the same 
time. The pain generally commences mildly and gradually 
grows worse; sometimes it is paroxysmal, generally worse towards 
evening and in the night, sometimes only during the day. 
Slight touch aggravates or provokes the pain, while a hard press- 
ure sometimes gives relief. With some the pain is ameliorated 
by moving about constantly, while others cannot bear the slight- 
est motion, so that coughing, sneezing, pressing at stool are 
almost killing operations to them. Sometimes the pain is attended 
with a cold sensation in the affected extremity, followed by heat. 
In other cases we find reflex symptoms of the motory nerves, 
manifesting themselves as cramps in the calves of the legs and 
in the soles of the feet. It has even been observed that during 
violent paroxysms the heel was drawn up towards the buttock of 
the affected limb. 

Painful points are: "a point close to the sacrum, in the imme- 
diate vicinity of the posterior superior spine of the ileum; a 



870 NERVES. 

point where the sciatic nerve emerges from the pelvis; a point 
at the lower border of the gluteus, where the posterior cutaneous 
nerve emerges; a painful line corresponding to the course of the 
tibial nerve in the popliteal space ; a point over the head of the 
fibula; a point behind the outer ankle-bone and another behind 
the internal malleolus; several points on the dorsum of the foot, 
and occasionally points on the posterior surface of the thigh and 
on the calf of the leg, where the cutaneous branches perforate the 
fascia." (Erb.) 

In regard to its Causes we are very much in the dark. At- 
mospheric influences, however, such as damp, cold weather, seem 
to be very apt to bring it on. Therefore we find among the 
exciting causes, getting wet, sleeping on the damp ground or 
within moist walls, or taking cold in general. Likewise are 
mentioned direct influences upon the nerves, such as pressure of 
narrow boots, wounds from blood-letting, carcinoma, aneurisms, 
pressure of the pregnant uterus, deliveries by the forceps, diseases 
of the vertebrae and neuroma. 

THERAPEUTIC HINTS.— Arg. nitr., periodical pain from hip 
down to knee, with paralytic weakness and wasting away of the 
limb; during paroxysm sensation of expansion in limb; worse 
morning and noon. 

Arnica, when caused by overexertion, marching, fracture of 
limb, confinement, etc., with formication and lame feeling; neces- 
sity to change the position of the limbs constantly, because every- 
thing upon which he lies seems too hard. 

Arsen., the burning pain is attended with anguish and restless- 
ness, and is worse about midnight; brought on by staying in 
cold, damp cellars; it is somewhat relieved by external warm ap- 
plications ; intermittent fever. 

Bellad., feverish; inclined to weep; wants to sleep and cannot 
sleep; pain worse from touch and motion; from least draught of 
air; from afternoon till midnight; better from letting limb hang 
down, and after perspiring; from warmth and when in erect 
position. 

Bryon., better during rest, and worse on motion. 

Chamom., pain excruciating; the patient acts as if beside him- 
self; after anger or vexation. 

Calc. carb., if caused by working in water; or in case of compli- 
cation with affections of the spinal bones; the pain starts from 



SCIATICA. 871 

the small of the back, extends down into the limbs and keeps 
them in constant uneasiness. 

Caustic, tearing pain on the outer side of left limb from above 
down, as if the muscles were pinched; constant desire to move 
the foot. (Marenzeller.) 

Cimicif., causes many reflex pains in different parts, dependent 
upon ovarian or uterine irritation. 

Coffea, tearing, stitching pain, in irregular spells, worse in the 
night, with restlessness and sleeplessness. 

Coloc, tearing downward, posteriorly, from hip to thigh, leg and 
foot, left or right side, during the day, not at night ; worse from 
motion and pressure ; must limp when walking, and be careful 
not to press the limb when sitting ; feels best when lying still. 
During paroxysm sweat and thirst. Eyelids burn even after 
sound sleep ; after indignation. 

Ferrum, remitting pains ; worse in the night, driving out of 
bed ; although at first scarcely able to stand upon the affected 
limb, by continued motion and walking about, the pain grad- 
ually becomes milder ; pain in the left shoulder ; the face is pale, 
emaciated, but flushes easily. 

Gnaphal., intense pain along the sciatic nerve, which is contin- 
ued to its larger ramifications ; feeling of numbness, occasionally 
taking the place of the sciatic pains, and then exercise on foot is 
excessively fatiguing. 

Hepar, the pain is worse from motion, touch, and exposure to 
air ; better from being wrapped up and keeping quiet. 

Ignat, throbbing pain in the hip, as though the joint would 
burst; intermittent, at first every other day — later, daily; attended 
with chilliness and thirst, followed by heat without thirst; disap- 
pearing during the summer season, and reappearing in the winter. 

Iris vers., burning and sudden shooting down the limb, causing 
lameness ; worse from moderate, not altered by violent motion. 

Kali bichr., pain relieved by walking and flexing the leg ; worse 
from standing, sitting or lying in bed. 

Kali hydr., nightly tearing in right thigh and knee, worse lying 
on affected side ; abuse of mercury ; syphilitic taint. 

Laches., pain constantly changing locality, now in the head, 
now in the teeth, now in the sciatic nerve, attended with ner- 
vousness, palpitation of the heart ; burning like fire in the hypo- 
gastrium, lumbar region, and behind the sternum; flushes of 
heat ; suppressed menses ; constipation. 



872 NEEVES. 

Ledum, laming pain in the hip-joint, worse in bed, when getting 
warm; the affected limb is cooler than the remainder of the 
body; general coldness and chilliness. The pain frequently 
commences below and ascends. Great tenderness of the soles of 
the feet. 

Lycop., pain in the hip, stiffness and weakness, and formication 
of the affected limb; cold feet; incarcerated flatulence and con- 
stipation ; urine high colored, turbid, or depositing a red, sandy 
sediment. 

Menyanth., the pain is of a crampy nature, and when sitting, 
the limbs are jerked upwards spasmodically. 

Mercnr., drawing, tearing pain, worse at night in bed ; restless- 
ness; great inclination to sweat, without any relief; syphilitic 
taint. 

Mezer., drawing pain through the affected limb, with sensation 
of internal heat in the limb by external coolness of the skin ; 
worse from touch and motion, in evening and at night ; better 
in the open air. 

Natr. mur., chronic cases with contraction of hamstrings ; inter- 
mittent; abuse of quinine. 

Nux vom., the pain is drawing, tearing, from below upwards, 
better from hot water application ; constipation ; during stool, 
great pain along the affected limb down into the foot ; sedentary 
life ; alcoholic drinks ; previous use of all sorts of liniments, etc. 

Plumbum, drawing, pressive pains in the sciatic nerve in the 
posterior part of the thigh, down to the knee, with difficult walk- 
ing and great exhaustion after walking; tubercular diathesis, 
with dr}', hacking cough. 

Phytol., neuralgic pain on the outer side of the thigh ; right 
side; pressing and shooting, drawing and aching: worse from 
motion and pressure, and worse in the night ; syphilitic taint. 

Pulsat, pain getting worse towards evening and in the night, 
with inclination to constantly change position ; worse in warm 
room ; better in open air. 

Rhus tox., the pain is attended with numbness, formication, 
paralytic stiffness of the affected limb ; it is worse during rest, 
and when commencing to move ; better from dry heat : it is 
mostly brought on by exposure to wet, by straining and lifting. 

Ruta, pain as if in the bones, worse in rest, must constantly be 
moving about during the paroxysm; hamstrings feel shortened: 
after injuries, contusions, etc. 



CRURAL NEURALGIA, ISCHIAS ANTICA — ANAESTHESIA. 873 

Sepia, during pregnancy, pain in paroxysms from three to five 
o'clock a.m., with considerable swelling of the veins of the affected 
limb ; also in chronic cases, when the pain localizes itself in the 
heel of the affected limb ; better during rest. 

Stilling., left side ; syphilitic and gonorrhceal origin. 

Sulphur, in chronic cases, when all other remedies fail; after 
the suppression of tetters. 

Tellur., worse when lying on the affected side. 

Valer., the pain is unendurable while standing, with a feeling 
as if the thigh would break off. 

Zinc, ox., pain in small of back at night, on turning in bed; 
feeling of lameness extending to hips ; bruised pain especially in 
left lower limb, or in hip and knee ; painful tension of muscles 
when moving ; pulsation and buzzing in ears. (F. W. Payne.) 

9. Crural Neuralgia, Ischias Antica. 

Its seat is the crural nerve ; the pain is felt from the inner and 
lower portion of the thigh, down to the "inner portion of the knee, 
the inner ankle, the inner portion of the foot, and the big and 
second toe. 

As Causes have been named : uterine swellings, especially of 
a cancerous nature; inflammation of the hip-joints and crural 
hernia. 

THERAPEUTIC HINTS.— Coffea, Phytol., Staphis. 
Compare Neuralgia and Sciatica. 

Anaesthesia. 

Anaesthesia takes place from two causes : 

1. Either from an inability of the sensory nerves to convey the ex- 
ternal impressions to the central organs ; or — 

2. From an inability of the central organs to perceive external im- 
pressions. 

The first is the case, for example, where a nerve has become 
cut through. Any irritation below that cut, towards the pe- 
riphery, is not perceived any more by the central organs ; that 
part may be pinched, burnt, etc., but it is not felt. The latter 
may have its source in a disease of the spine or of the brain. In 
both cases the want of feeling is chiefly associated with paralysis 
of the corresponding parts. 



874 NEKVES. 

The degree of such anaesthesia varies from a mere numbness 
to torpor and deadness of the part. Its influence upon the vege- 
tative functions in the affected parts shows itself as : decrease in 
na.tural warmth ; slowness of capillary circulation ; want of per- 
spiration ; subcutaneous oedema ; livid color of the skin ; brittle- 
ness of the nails; ecchymosis, and blisters filled with bloody 
serum, especially on the toes and fingers. 

Of the different forms of this affection I shall mention only the 
following : 



Anaesthesia of the Trigeminus. 

According to the extent to which this nerve has lost its ability 
to convey external impressions to the sensorium, we find a want 
of feeling in the corresponding portions of the skin and mucous 
membranes. The patient does not feel any external irritation in 
these parts ; when eating, knows not whether he holds anything 
in the affected side of the mouth or not ; the saliva runs out of 
the mouth without his knowledge; and the glass held on his lips 
seems to him broken off where it touches the affected side. In 
addition, there is likewise found weakness of sight, loss of smell 
and taste. 

The reflex motions of the muscles of the face are gone, the 
eyelids do not shut when the conjunctiva is touched, and the 
patient does not sneeze when the mucous membrane of his nose 
is irritated. Also the voluntary muscular motions of the affected 
side are more torpid, and the pupil is contracted and immovable. 

The seat of the affection is, according to Romberg's observa- 
tions, more towards the periphery of the fifth pair of nerves, 
when the anaesthesia is limited to some of its fibres. 

When, however, the amesthesia affects not only the external 
surface of the face, but also the corresponding cavity of the eye, 
then the cause lies in one of the main branches of the trigeminus, 
either before or after its exit from the skull. When the an- 
aesthesia extends over the whole ramification of the trigeminus, 
the cause of the affection then lies in the ganglion Gasscri, or im- 
mediately below it in the nerve. 

When, however, the affection is combined with disturbances 
of other cranial nerves, its seat lies in the base of the brain. A 
central anaesthesia affects crosswise, and involves at the same 
time other sensory and motory nerves of the head and body. 



SPASM, CONVULSION, CRAMP, HYPERKINESIS. 875 

Central Causes are: apoplexy, softening, and tumors of the 
brain. 

Peripheric Causes: inflammation; softening; hardening and 
atrophy of the nerve and of the ganglion Gasseri. Likewise the 
severing of the nerve or of one of its branches by surgical opera- 
tions, or other external injuries, blows, wounds, etc. ; or pressure 
upon it in consequence of tumors or foreign bodies, like musket 
balls, or fracture of the petrous portion of the parietal bone. 

These causes show at once all that might be said about its 
prognosis and curability. 

Just as the sensory nerves may be morbidly affected in a two- 
fold manner, either by an increase or a loss of their sensibility, so 
also are the morbid affections of the motory nerves of two kinds, 
either spasm, cramp, hyperkinesis ; or paralysis, akinesis — that is, 
increased or lost motility. 

1. Spasm, Convulsion, Cramp, Hyperkinesis. 

Spasms manifest themselves under different forms : 1. Either 
as short, slight jerks of certain muscles; or, 2. as violent, fre- 
quently-repeated contractions of the same or different sets of mus- 
cles (clonic spasms) ; or, 3. as hasty motions which, although 
regular, are deficient in purpose and rhythm or are automatically 
repeated ; or, 4. as irregular, misdirected motions (in-coordinated 
spasms); or, 5. as trembling or tremor; or, 6. as a continuous 
rigidity of one or more sets of muscles, even of all muscles (tonic 
spasms) ; and, 7. as a permanent contraction of certain muscles 
(contractures). Their violence and extent are very different, and 
do not always correspond to the importance of their cause. Grave 
disorders in the central organs may be attended with but slight 
spasms ; whilst, vice versa, a slight reflex irritation may cause the 
most violent convulsions. 

Their Causes are various : I may mention as predisposing ones, 
the age of childhood — the younger the child, the greater the pre- 
disposition. Almost any acute disease may be attended by spasms 
at this age, and frequently is preceded by them. Even in chills 
and fever, little children have spasms instead of a chill. As spe- 
cial forms of spasms in this early age I may mention eclampsia 
and trismus. In later years, up to the time of puberty, we find a 
predominating disposition to the different forms of chorea, stam- 
mering and squinting, and likewise the beginning of epilepsy. 



876 NERVES. 

From the time of puberty to middle age we find hysteria, epilepsy, 
eclampsia and tetanus. In still later years we find writing spasm, 
and tremor. The female sex seems to be more disposed to spasms 
than the male. 

As Exciting Causes we may mention — 

1. Mental emotions: fear, fright, anger, terror. Even the sight 
of convulsions has caused them in others. Epileptic fits have 
become endemic in this way among the pupils of a whole 
asylum. 

2. Diseases in the central organs and their membranes, like apo- 
plexy, softening, encephalitis, myelitis, tumors, tubercles, inflam- 
mation of the cerebral and spinal membranes, and morbid pro- 
cesses in the bones which encase the central organs. 

3. Peripheric irritations of the nervous system, by strong light, 
tickling; also by wounds, blows and bruises of some organs, like 
the testicles or the uterus, or by irritation of large surfaces, like 
the mucous membranes — for example, the intestinal canal by 
indigestible food or worms, or the external skin by sudden tak- 
ing cold, etc. 

4. Various conditions of the blood, such as (according to Mar- 
shall Hall) great loss of blood or stagnation of blood within the 
brain; so, also, qualitative changes of the blood in exanthematic 
fevers, in pyaemia, uraemia and cholreinia. 

5. Certain poisons: alcohol, narcotics, strychnine, secale, lead 
and mercury. 

The Prognosis of spasms depends entirely upon their causes. 
When they appear in consequence of organic lesions in the cen- 
tral organs, they are of a much graver nature than when in con- 
sequence of a mere peripheric irritation. 

Spasms which appear during the beginning or during the 
course of other diseases, like exanthematic fevers, are a sign that 
the disease, with which they are combined, is of a violent charac- 
ter, but are not quite so bad a sign, when they occur in children 
as in grown persons. Spasms from blood-poisoning in uraemia 
and cholsemia are always a bad prognostic sign. 

I shall now speak of the different forms of — 



SPASMUS FACIALIS. 877 

SPASMODIC DISEASES. 
1. Spasmus Facialis, Mimic Spasm of the Face. 

It affects those muscles of the face which are supplied hy the 
seventh pair of nerves, either on one or both sides. 

In its clonic form it causes the most awkward appearance of 
the face; whilst one side looks perfectly quiet and natural, the 
affected side is continually in motion, cutting all sorts of capers 
and jerks. The will has not the slightest influence over these 
distortions. They come on unprovoked, and may last a shorter 
or longer time. In some cases they are brought on by a usual 
effort to talk, chew, etc., disturbing these natural muscular 
actions greatly. 

The tonic spasm is different. The face appears as though, dur- 
ing a distortion, it had .suddenty become rigid, stiffened, so that 
it does not partake of the motions of the sound side, which mani- 
fests itself especially in laughing or whistling. This rigidity 
might give occasion to confound it with paralysis of the face. 
However, chin, lips and nose are drawn towards the affected 
side ; the corner of the mouth of the affected side is drawn down- 
wards, whilst the eyebrow is drawn upwards. The eyelids of the 
affected side cannot be perfect^ closed, and the mouth not per- 
fectly opened, thus interfering with talking and chewing. The 
muscles of the affected side are hard to the touch, and the patient 
has a feeling as if they were stretched. 

As the most frequent Cause of this complaint, may be men- 
tioned : suddenly taking cold by exposure to a sharp, piercing 
wind, rain or snow driven into the face. Likewise external in- 
juries, especially bruises of the bones of the face and skull, de- 
cayed teeth, etc. Violent mental emotions, like anger or terror, 
and hysteric conditions have also been observed as causes of this 
complaint. 

THERAPEUTIC HINTS.— When caused by exposure to cold, com- 
pare Bellad., Hyosc, Mercur. 

When caused by external injuries, Arnica, Hyper. 

W T hen caused by diseases of the bones, decayed teeth, Hepar, 
Mercur., Silic. 

When caused by anger, Nux vom. 

When caused by fright and terror, Hyosc, Ignat., Opium. 



87» SPASMODIC DISEASES. 

Constant winking of the eyelids, Anac, Bellad., Stramon. 

Rims sardonicus, compare Aeon., Anac, Alum., Asaf., Bellad., 
Bovista, Calc. carb., Cicuta, Conium, Crocus, Cuprum, Hyosc, 
Natr. mur., Nux mosch., Phosphor., Platina, Ran. seel., Sepia, 
Stramon., Veratr., Zincum. 

2. Mogigraphia, Graphospasms, "Writers' Cramp, 
Pianists' Cramp, etc. 

It commences first as a mere tired feeling of the hand, after 
long-contiuued writing. By and by this feeling increases, and 
the writer has to make pauses frequently in order to rest the 
hand ; lastly, it is quite impossible to hold the pen and to write, 
because, 1st, either a spasm of the extensors draws the fingers as- 
under, or, 2d, a spasm of the flexors of the first three fingers, or 
of only one of them, makes it impossible to hold the pen. Such 
spasms may be clonic or tonic. Sometimes the thumb and 
fingers are only slightly drawn together, and writing might be 
possible, if it were not for the strong trembling which attacks 
the hand and the whole arm up to the shoulder, as soon as writ- 
ing is attempted. 

If writing be attempted with the other hand, it is not long be- 
fore the same spasms attack it also. 

It is quite remarkable that all other manual acts can be easily 
executed, although in some cases cramps and tremors attend 
them likewise. 

Similar spasmodic affections have been observed also in the 
habitual performances of shoemaking, milking, playing musical 
instruments, setting type, sewing, etc. Its causes seem to be 
overexertion in writing, or disturbance in the co-ordinating ap- 
paratus. It is increased by anxiety, and constant thinking of it. 

The most important remedies are Bellad., Caustic, Gelsem., 
Ignat., Nux vom., Ruta, Secale, Silic, Stannum, Staphis., Zincum. 
Light and large penholders ought to be used. 

Chorea, St. Vitus' Dance 

Is defined now as a neurosis, the seat of which is supposed to be 
at times in the brain alone, at times in the entire nervous sys- 
tem; it is characterized by incessant incoordinate twitchings and 
jerkings of groups of muscles, either spontaneous in origin or ex- 



CHOREA, ST. VITUS' DANCE. 879 

cited by voluntary impulse, exclusively occurring in the waking 
state and accompanied b} r more or less developed psychical dis- 
turbance. (Von Ziemssen.) Dr. J. Lawrence Newton recognizes 
five forms : the true cerebral, the spinal, the uterine, the intes- 
tinal and rheumatic form. Chorea is prominently an affection 
of the period of bodily development, but is seen also : during 
pregnancy ; in consequence of disturbances of menstruation and 
sanguification (chlorosis, ansemia), and in frequent connection 
with articular rheumatism. As Exciting Causes have frequently 
been observed : mental emotions, such as fright, or fear, etc. 

Symptoms. — 1. Involuntary motions sometimes extend to all the 
muscles which obey the will ; sometimes they are confined to 
certain groups of them, oftenest to the upper half of the body ; 
sometimes only one side is agitated, and in exceptional cases we 
find a crosswise agitation — an arm of the one,, and the leg of the 
other side. Again, involuntary motions sometimes commence in 
a few muscles only, gradually extending over the whole side, 
and finally to the muscles of the whole body. We then find the 
whole body in constant agitation, jerking, twisting, swinging, a 
ludicrous and sometimes pitiful sight. There is no interruption 
of these irregular motions, except during sleep, which is gener- 
ally restless and unrefreshing ; and even then they recur, 
although in a less degree, when the patient dreams. On waking 
the same tumultuous scene commences again. 

2. The regular voluntary movements of the body are thus greatly 
interfered with, and at last cannot be executed at all. Dressing, 
writing and playing instruments become impossible, talking dif- 
ficult and exertions to overcome the difficulty have always had 
the contrar} r effect — increase of spasmodic action. 
• 3. The reflex motions, however, are not disturbed. If the pa- 
tient itches somewhere, he can scratch himself without any 
trouble; so can he sneeze, cough and evacuate bladder and 
bowels, etc. 

4. All other involuntary motions of the body are perfectly free in 
their action ; there is no interference in breathing, in the pulsa- 
tions of the heart, nor in the act of swallowing, and the peristal- 
tic motions of the intestine are normal. 

5. The sensibility is in most cases normal. 

6. The mental functions, however, suffer considerably from a 
long duration of the disease. The patient at length shows a loss 
of memory, weakness of mental capacity, and in some severe cases 



880 SPASMODIC DISEASES. 

even imbecility of mind; the disposition becomes fretful, irritable 
and peevish. 

Chorea is of a chronic nature and its duration extremely vari- 
able. It is apt to recur, and relapses are especially frequent after 
mental excitement. Under judicial homoeopathic treatment it is 
in most cases easily cured. 

THERAPEUTIC HINTS.— Agar., the spasmodic motions range 
from simple, involuntary motions and jerks of different muscles 
to a dancing-like turning of the whole body; or attack crosswise, 
an upper right and a lower left extremity, or vice versa; frequent 
nictitation of the eyelids; redness of the inner canthus of the 
eyes; flow of tears from the eyes; sensitiveness of the lumbar 
vertebrae; ravenous appetite, but difficult swallowing; cervical 
glands swollen; worse during the approach of a thunder-storm. 

Ast. rub., trembling jactitation of arms and legs ; unable to feed 
herself or to walk ; frequent, clear, profuse urine; after fright and 
mental depression. 

Bellad., throwing the body forward and backward in lying, a 
kind of constant changing from emprosthotonus to opisthotonus; 
boring the head into the cushion ; grating of the teeth ; sore 
throat; numbness in the fingers; soreness of the last lumbar 
and the first dorsal vertebne ; after mental excitement ; fright. 

Gale, carb., sometimes only one-sided involuntary motions ; some- 
times amounting to falling down; exceedingly headstrong ; pe- 
riod of second teething; worm symptoms; scrofulous habit: 
onanism. 

Cauloph., in young girls with menstrual irregularities. 

Caustic, distortion, twisting and jerking of the limbs, even in 
the night, preventing sleep ; paralysis of the tongue and the 
right side of the body ; after suppressed eruption on head. 

Wm. Gross mentions a peculiar case of a young girl, who had 
the following paroxysms: the child would lay down on her stom- 
ach, and inserting one of her knees into the hollow of the other 
knee, and drawing her feet upwards upon the buttocks, her body 
would commence jerking forward and backward, simulating the 
movements exercised during coitus ; at the same time the mus- 
cles of her face became contorted, like risus sardonicus. After 
the attack the child was exhausted, but during the intervals she 
showed no particular symptoms; the spells were worst in the 
morning. 



CHOREA, ST. VITUS' DANCE. 881 

Cimicif., chiefly on the left side only ; worse during the men- 
strual period ; after suppression of the menses ; from rheumatic 
irritation ; frequent alternation of heat and cold in different parts 
of the body. 

Cina, the distortions often commence with a shriek, extend to 
the tongue, oesophagus and larynx, and continue even through 
the night; they are attended with frontal headache; enlarged 
pupils; dark rings around the eyes; itching of the nose; pale, 
yellowish, earthy face; ravenous appetite; pain around the um- 
bilicus ; hard stools ; turbid urine ; emaciation ; all pointing to 
irritation of the intestines by worms. 

Coccul., involuntary motions with the right arm and right leg; 
they cease during sleep; face puffed, somewhat bluish; hands 
look as if frozen ; paralytic symptoms. 

Crocus, jerking in the muscles; spasmodic contractions of single 
sets of muscles; jumping, dancing, laughing, whistling; wants 
to kiss everybody ; congestion of the head with bleeding of the 
nose ; suppressed menses. 

Cuprum, commences in one arm and spreads over the whole 
body, causing the most terrible contortions and awkward move- 
ments ; inability to speak, or only imperfectly ; after fright. 

Hyosc., throwing about of the arms; misses what he reaches for; 
constant falling of the head from side to side; tottering gait; very 
talkative, or loss of speech ; laughs at everything that is told 
him ; smiling, silly expression of countenance ; after typhus. 

Ignat, especially when caused by fright or other mental excite- 
ment ; worse after eating ; better when lying on the back. 

Lauroc, she tears her clothing ; strikes at everything ; spasmo- 
dic deglutition; indistinct articulation; she gets angry because 
she cannot be understood ; idiotic expression of the face ; cold, 
clammy feet up to the knees ; she can neither stand nor sit, nor 
lie down, on account of the incessant motion; wasting away; 
after fright. 

Lil. tigr., convulsive contractions of almost all the muscles of 
the body, and a feeling as if she would be crazy if she did not 
hold tightly upon herself. 

Mygale, constant jerking of head to the right side, occasionally 
drops his head suddenly on his shoulder, sometimes he twists his 
head around to the right shoulder ; twitching of the muscles of 
back and arms ; pain in knees when walking ; in attempting to 
control these involuntary motions, he loses his breath, until he 
56 



882 SPASMODIC DISEASES. 

takes a deep inspiration. Twitching of muscles of face and upper 
extremities ; convulsive movements of the shoulders ; lower ex- 
tremities in constant motion ; drags her legs when walking ; 
mouth and eyes open and shut in rapid succession. (Howard.) 

Natr. mur., chronic cases after fright or suppression of eruptions 
on the face; worse during full moon; paroxysms of jumping 
high up without taking notice of the things around him, thus 
hurting himself sometimes considerably; or mere jerkings of the 
right side and of the head. 

Nux vom., when attended with a feeling of numbness in the 
affected parts ; also after much drugging. 

Opium, twitching and trembling of head and arms; throws 
limbs or stretches arms at right angles to body ; after fright. 

Phosphor., he walks like one paralytic, without noticing it him- 
self; twitching of the limbs; great exhaustion; after Calc. curb.; 
during second dentition ; in general, during the period in which 
the body is growing. 

Seeale, the morbid contractions usually commence in some mus- 
cles of the face and spread thence over the whole body, and increase 
even to dancing and jumping motions. 

Sepia, convulsive motions of tbe head and limbs; when talking 
(which is only a stammering), jerking of the muscles of the face; 
general muscular agitation ; desire to constantly change position 
and place ; ringworm-like eruptions on the skin every spring. 

Sticta, she cannot keep her feet to the ground ; they jump and 
dance around in spite of her, unless held fast : when lying down, 
her limbs feel as though they were floating in the air as light as 
feathers. 

Stramon., the convulsive motions are often crosswise, or violent 
all over; preceded by formication in the limbs and a melancholy 
mood ; worse during the equinoxes ; inclination to pray ; loss of 
memory; stammering; loss of speech; putting the hands to the 
genitals. 

Sulphur, in chronic cases : after suppressed eruptions : weak, 
faint, hungry spells about 10 a.m. 

Taraut, trembling of the body; all the limbs are agitated : is in 
constant motion ; can run better than walk ; feels best in bed. 
Spasms subside on hearing the notes of a hornpipe; music 
lessens the symptoms. 

Ver. vir., most violent distortions of the body, universal, un- 
affected by sleep ; lips embossed with foam ; waked up by a eon- 



HYSTERIA. 883 

tinual champing of the teeth ; inability to swallow ; intense 
sexual excitement. 

Viscum alb., common mistletoe, is a popular remedy in England. 

Zincum, especially in those cases in which the general health 
suffers much from the disease, with great depression of spirits: 
worse after drinking wine. 

Hysteria. 

This hydra-headed complaint must be classed among the 
neuroses, in which at times part or the whole nervous system 
participates, without the presence of any apparent anatomical 
basis. Its most constant feature consists of an abnormal irrita- 
bility, with neuralgic pains, and hallucinations in the sensory, 
and convulsions in the motor sphere; or the reverse, anaesthesia 
and paralysis. Although unmistakably a connection exists in 
many cases between the female genital organs and this com- 
plaint, it is nevertheless an erroneous assumption that hysteria 
is a disease exclusively peculiar to the female sex. However, the 
female sex does contribute the largest number of patients, espe- 
cially during the ages between 10 and 30 years; after the climac- 
teric period its occurrence is rare. 

As important Etiological data must be mentioned: a peculiar 
psychical constitution, liable to changing emotions and little 
strength of will; disorders of the female genital organs, menstrual 
disturbances, non-gratification of the sexual appetite, or over- 
irritation ; persistent depressing mental emotions, such as the sense 
of failure in one of the objects of life (childless women and old 
maids), love-sickness and jealousy, injured vanity and wounded 
pride, self-reproach because of secret sins, grief and anxiety, etc. ; 
educational influences, such as too great indulgence, or too great 
demands upon the mental capacity, by overburdening with les- 
sons, and overstimulating the ambition. 

The Symptoms of hysteria are exceedingly various and vari- 
able. We find in the sense of sight, photophobia, or dislike to 
particular colors, such as the red, or subjective light-phenomena, 
such as simple flashes, sparks, or more complicated figures, phan- 
tasms, and even visionary hallucinations; in the sense of hearing, 
oversensitiveness, or ringing, blowing, roaring, or hearing of 
voices; in the senses of smell and taste, various kinds of idiosyn- 
crasies, such as aversions to different sorts of scent or taste which 



884 SPASMODIC DISEASES. 

are not unpleasant to others, or a desire to smell asafoetida, or to 
devour chalk, coal and other such things; in other sentient nerves, 
all kinds of pain and abnormal sensations, such as headache, tic- 
kling cough and pain in the larynx, soreness of the mouth and 
tongue, neuralgia of the mammary glands, heavy dull pain and 
oppression in the chest and about the heart, cardialgias and gone 
feeling in pit of stomach, tightness in the epigastrium, pains in 
the hypochondria, in the bowels, in the ovaries, in the womb, in 
the external genitals, in the bladder and urethra, in the coccygeal 
region, in the back — spinal irritation, and in the extremities. 

Or we find anaesthesia of the sense of touch, or in some of the 
limbs, or in a portion of them, or on one-half of the body, espe- 
cially the left, or, but rarely, over the whole surface of the body. 
With the loss of cutaneous sensibility, a similar loss of sensibility 
in the muscles, as well as in the hands and joints may be united, 
and it may extend over the mucous membranes of eyes, nose, 
mouth, respiratory organs, genital organs and urinary passages. 
In the higher senses, amblyopia, amaurosis and deafness have 
been observed. 

We find also spasms of various descriptions, such as globus 
hystericus in the throat, or the rising of a ball from the region of 
the symphysis toward the stomach ; spasmodic breathing, singul- 
tus, yawning, convulsive laughing or crying, or screaming; spas- 
modic retention of urine, spasm of the constrictor ani; local 
spasms in all possible sections of the muscular system of the head, 
trunk and extremities, even general convulsions, or similar to 
chorea and epilepsy. Or we find paralytic conditions of the pha- 
rynx and oesophagus (hindering deglutition), of the bowels (pre- 
venting a spontaneous expulsion of gases and feces), of the vocal 
cords (producing aphonia), of the bladder (causing retention of 
urine), of the extremities, either in the hemiplegic or paraplegic 
form, or crosswise, or of only one extremity, or of all four. In 
the palsied extremities a permanent contraction not unfrequently 
develops itself. Both paralysis and contraction may last for 
years and may be cured by all kinds of moral influences, or resist 
them all. 

We also find changes in the circulation, powerful palpitation of 
the heart, or weakness of its action, pale and cold extremities, red 
face and hot head, with perspiration : also unilateral sweating — 
all changing with normal conditions. 

In some cases hemorrhages have been observed from the nose, 



HYSTERIA. 885 

throat, stomach and lungs, and in rare cases from different por- 
tions of the skin (stigmatization), all mostly of a vicarious nature; 
salivation or its opposite, abnormal dryness of the mouth, occurs 
sometimes after hysteric fits; the hysterical vomiting of large 
quantities of fluid seems to be in connection with a suppression 
or lessening of the renal secretion, and therefore likewise of a 
vicarious nature. The urine is often copious, clear, of low specific 
gravity (urina spastica) and frequently voided, especially after 
spasmodic attacks; at other times its secretion is diminished and 
coupled with spasmodic closure of the neck of the bladder, so 
that the small quantity which exists must be removed by the 
catheter. Leucorrhcea has often been found to increase after 
hysterical attacks. 

The hysterical attacks themselves vary greatly in their forms, 
according as more or less of the above detailed symptoms com- 
bine in greater or less intensity. One form has been styled the 
hystero-epileptic, on account of the similarity of its convulsions to 
epilepsy, another the cataleptic, another the hysterical trance, to 
which some have added somnambulism, sleep-walking, mag- 
netic sleep, hypnotism and ecstacy — an exhibition of elasticity 
of the term "hysteria" that leaves nothing to wish for and is 
truly marvelous. 

THERAPEUTIC HINTS.— Being a functional disorder, hysteria is 
certainly amenable to treatment. Quite important here is the 
personal, psychic and moral influence of the physician upon his 
patient. The remedial agents are necessarily very numerous in 
a disease of so varied and variable a character. I shall, however, 
confine my remarks to but few characteristic hints of the several 
remedies, and refer for fuller descriptions to the chapters on 
spinal irritation, neuralgia, spasms, paralysis and uterine disor- 
ders. 

Aeon., fear to go into crowds ; fear of death and predicting the 
hour of her death. 

Agar., crosswise complaints. 

Anac, forgetful, and irresistible desire to curse and swear. 

Arsen., spasmodic dyspnoea, with fear of death. 

Asaf., dryness of oesophagus ; globus hystericus. 

Auram, melancholy; longing for death; palpitation; alternate 
laughing and crying. 

Bellad., congestions to head; spasms; hallucinations. 



000 SPASMODIC DISEASES. 

Calc. carb., fears she will lose her reason; coldness in and on 
head; cold, damp feet; palpitation after eating; chorea-like and 
epileptiform spasms. 

Caustic, paresis of upper eyelids. 

Chamom., exceedingly irritable, peevish and impatient. 

Coccul., tickling cough; choking in throat; oppression of chest; 
paralysis of tongue or pharynx. 

Conium, old maids; non-gratification of the sexual appetite; 
globus hystericus. 

Cuprum, spasmodic affections. 

Gelsem.. paralytic symptoms in throat, in limbs; spasms from 
reflex irritation ; cataleptic immobility, with dilated pupils, closed 
eyes, but consciousness. 

Hyosc, illusions; silly expressions and silly actions; jealousy; 
disappointed love. 

Ignat, choking in throat and constriction of chest, with sighing- 
breathing; tickling cough which may be suppressed by an effort 
of will ; feeling of goneness and gnawing in pit of stomach : grief. 

Iodium, rapid failing of strength and emaciation in spite of 
eating freely. 

Laches., sensation of a lump in throat which descends on swal- 
lowing, but returns at once; suffocating sensation, with constant 
efforts to remove all external pressure from throat and chest ; 
feels worse on waking ; jealousy. 

Lil. tigr., hurried manner without accomplishing anything; 
weak, nervous ; uterine troubles ; palpitations. 

Lycop., full and satiated ; rumbling in upper left side of abdo- 
men ; sandy or pale urine. 

Magn. mur., fainting fits at dinner, nausea and trembling, re- 
lieved by eructations ; spasmodic complaints. 

Merc, sol., profuse saliva ; perspiration without relief. 

Moschus, anguish and fear of death : swooning: tetanic spasms. 

Natr. mur., desire for salt; somnambulic states ; pain in urethra 
after micturition. 

Nitr. ac. longing for fat, herring, chalk, lime, earth ; twitchings 
in various parts : trembling : great weakness. 

Nux mosch., inclined to laughter ; drowsy ; great dryness of 
mouth ; leucorrhcea in place of menses. 

Nuxvom., pressure and pain in pit of stomach , belching; long- 
ing for chalk; tendency to faint; chronic spasms, with numbness. 

Pallad., feels best in company and wants to be flattered ; easily 
wounded pride. 



TRISMUS AND TETANUS. 887 

Phosphor., alternation of laughing and weeping; sense of weak- 
ness in abdomen; dry, hard stools; increased sexual desire. 

Platina, pride, haughtiness; illusions; spasms alternating with 
catalepsy, or with dyspnoea; sexual erythism; physical symp- 
toms alternate with mental symptoms. 

Pulsat, mild, tearful, yielding, timid; peevish; changeable; 
loss of smell and taste; no appetite and no thirst; increased mu- 
cous secretion from different orifices. 

Sabina, irritable in temper; abortion in third month. 

Sepia, sensation of something twisting about stomach and ris- 
ing to throat, with stiffness of tongue, speechlessness, and rigidity 
all over; spasms; fainting with profuse sweat; undisturbed con- 
sciousness and inability to move. 

Stannum, feels fainty from going down stairs; cannot sit down 
slowly, drops down; rises without difficulty. 

Staphis., great indignation on least occasion. 

Stramon., hallucinations; desire for light; great sensitiveness; 
weeping and laughing alternately; sexual excitement. 

Sulphur, flushes of heat; heat on top of head; cold feet; sensa- 
tion of hunger in forenoon. 

Tarant, choreic restlessness of limbs; music has a soothing in- 
fluence. 

Valer., ecstacy ; overexcitable, changeable disposition and ideas ; 
jerking, twitching, trembling. 

Veratr. alb., cold sweat on forehead and elbows. 

Ziucum, fidgetiness of feet and lower extremities. 



Trismus and Tetanus 

Are characterized as tonic contractions of the voluntary muscles, 
alternating with convulsive concussions. It is seldom that the 
disease is at once fully developed. Several days before its out- 
break, chilly sensations are occasionally felt, even shaking chills, 
and aura-like pains from the injured part of the body. There 
are at first drawing pains in the neck and stiffness in the nape 
of the neck, with some difficulty of swallowing. These symptoms 
increase; the head becomes immovable and drawn backwards, 
the masseter muscles grow rigid, the lower jaw is set, and deglu- 
tition still more difficult, even impossible. This state of things 
is called trismus or lockjaw. But frequently the tonic spasm 
gradually extends over all the dorsal muscles, down to the sac- 



888 SPASMODIC DISEASES. 

rum, and over the muscles of the chest and abdomen, so that the 
whole body becomes as hard and rigid as a piece of wood. The 
muscles of the extremities are not quite so severely affected, and 
sometimes not all. The muscles of the face are likewise less 
severely involved ; but still they participate more or less. There 
is a peculiar tension and painful expression in them. The eye- 
balls are rigidly drawn towards the inner canthus, and during 
the convulsive exacerbations the forehead becomes corrugated ; 
the eyebrows frown, the eyes stare, the lips are drawn asunder, 
showing the teeth ; the tongue is thrust between the teeth, and 
frequently severely bitten. There is often risus sardonicus. This 
is tetanus. 

The general tonic spasm of the voluntary muscles, however, 
has its remissions, that is, the rigidity of the muscles yields occa- 
sionally to a more relaxed state, until either without any external 
cause, or by some external influence under a sudden general con- 
vulsive concussion, the highest degree of rigidity again sets in. 
Sometimes these recurring concussive jerks are so violent that 
the patient is thrown backwards and forwards, while in other 
cases they resemble only electric shocks. In this way the disease 
progresses, alternating with rigidity, partial relaxation, and con- 
vulsive concussions. The contractions are so violent that in most 
of the cases single bundles of muscular fibres are torn and ex- 
travasation of blood takes place. The following forms of these 
spasms have been recognized : Opisthotonus, a bending of the body 
backwards, even to such a degree that the patient lies upon his 
heels and the back of his head; emprosthotonus, a bending of the 
body forwards; pleurothotonus, a bending of the body sideways; 
and orthotonus, being stretched out straight. The most frequent 
form is opisthotonus ; all other forms are quite exceptional. 

As long as the spasm prevails, the will has not the slightest in- 
fluence over the muscles. On the contrary, an effort to check 
the spasm only increases the rigidity of the muscles, and likewise 
do all reflex irritations, so that, as is well known, even the slight- 
est touch, movement of the bed, or even a draught of air, is suffi- 
cient to instantly cause the most violent convulsive concussions. 

The respiratory action is, of course, greatly interfered with, in- 
asmuch as all the respiratory muscles are involved in the affec- 
tion ; where the remissions are of but short duration, we find 
dyspnoea in a high degree, and sweat, sometimes even danger of 
suffocation. 



TRISMUS AND TETANUS. 60\) 

The pulse during the remissions usually is normal, or only 
slightly accelerated; but during the paroxysms it may reach 180, 
and the heart may suddenly cease acting during the attack. The 
temperature rises in many cases to 112.73° F., while in others it 
does not increase, or only slightly towards evening. 

There is great pain in the muscles during their contractions, 
and especially is there a painful sense of pressure in the pit of 
the' stomach, with extreme anxiety and excitement. 

There is usually distressing thirst, and in some cases actual 
hunger, neither of which can be satisfied ; the bowels, as a rule, 
are constipated, and micturition is often impossible; the urine 
has, in some cases, been found to contain albumen, and in others 
sugar. 

The skin is generally hot and covered with perspiration, as in 
violent muscular exertions, and is followed by sudamina. 

The functions of the brain seem entirely unmolested; the pa- 
tient has to suffer all these tortures in full consciousness. 

Sleep is entirely absent, and if the patient loses himself for a 
moment- in consequence of exhaustion, he is at once roused 
again by violent concussions. This is the character of all kinds 
of tetanus. 

Trismus or Tetanus neonatorum presents, on the whole, the same 
features ; commencing at first with stiffness of the jaws and con- 
sequent inability to suck and swallow, the tonic spasms extend 
gradually downward and also implicate the extremities. Signs 
of collapse soon appear, and recovery is still more uncommon 
than in cases of adults. 

The exciting Causes of tetanus are : 

1. External injuries of peripheric nerves of the extremities, face, 
and genitals; likewise parturition and abortus. In new-born 
children, inflammation of the navel. 

2. Rheumatism in consequence of taking cold. 

3. Lesions of inner organs: injuries of the uterus, pleuritis and 
hepatization of the lung. 

4. Poisoning by strychnine or brucine. 

An anatomical basis of this affection is not known. 

THERAPEUTIC HINTS.— Aeon., trismus and tetanus; contorted 
eyes; face changing color, now red, now pale again. 

Angust, opisthotonus from external injury ; tetanic pains from 
injured foot up to back and neck; jaws stiff; two weeks after a 
needle had been run in foot. 



890 SPASMODIC DISEASES. 

Arnica, after bruises; hot head, cool body; longing for alco- 
holic drinks; internal chilliness, with external heat. 

Bellad., at the commencement, when there is: restlessness; sud- 
den jerks and shrieks during sleep; twitching of the muscles of 
the face and limbs; squinting; inability to swallow; later: con- 
vulsive motions; spasmodic respiration; dilated pupils; staring, 
open eyes. Wound healed but left a dark, tender spot; foot and 
leg swollen. 

Calc. carb., inflamed umbilicus of infants. 

Camphora, antidote to strychnine. 

Cicuta, suddenly becoming stiff and immovable; tetanic stiff- 
ness of the whole body ; opisthotonus ; face puffed and bluish, or 
deadly pale and cold; eyes fixed, staring at one point; foam at 
the mouth; spasm of the chest, afterwards trembling; cannot 
recollect; the spasms are renewed from slightest touch, even 
from opening the door, and from loud talking. 

Hyper., after running pins in right foot, pain runs up the limb 
through spine to neck and face; muscles of neck and jaw be- 
come rigid, and also the muscles of chest and abdomen. (W. F. 
Hocking.) Piercing wounds from pointed instruments should 
always be treated with Hyper, to prevent any untoward symp- 
toms. 

Laches., peculiar tetanic look, half closed eyes and stiffness of 
neck; partial lockjaw; rigidity and pain in muscles of back. 
After cutting off two outer phalanges of third right toe, by being 
run over by a carriage wheel; soft parts of toe looked gangren- 
ous nine days after accident. (M. L. Sircar.) 

One week after frost-bitten toe which had ulcerated, rigors, 
shooting pains in back, opisthotonus and trismus; remission 
midnight till noon; after midnight profuse sweat and agitated 
sleep; throat sensitive to contact; swallowing fearful. (I. Heber 
Smith.) 

Lycop., drawing of the head towards the right side, with stiff- 
ness of the neck, face and jaw; dizziness; heaviness in the head; 
weak eyes; dry and stuffed-up nose; dry, difficult stool; restless 
sleep; full of anxious dreams; much depressed in spirits. 

Moschus, stiffness of the body, with full consciousness; spasms 
in the abdominal muscles. 

Nux vom„ intermitting fits of spasms; disturbed respiration ; 
consciousness not disturbed; renewal of spasms from slightest 
reflex-irritation. 



CATALEPSY. 891 

Phytol., has caused the following symptoms: extremities stiff; 
hands firmly shut; feet extended and toes flexed; pupils con- 
tracted ; teeth clenched ; lips everted and firm ; general muscular 
rigidity, opisthotonus ; respiration difficult and oppressed ; con- 
vulsive action of the muscles of the face and neck, followed by 
partial relaxation, which again was succeeded by the same tetanic 
condition. 

Platina, opisthotonus alternating with spasms, with full con- 
sciousness ; profuse menses ; overbearing, proud disposition. 

Rhus tox., in consequence of taking cold from getting wet. 
• Secale, after abortus, spasms with full consciousness, afterwards 
great exhaustion ; heaviness in the head and tingling in the legs. 

Stramon., opisthotonus and trismus, with congestion to the 
head ; red face ; heat of the body ; profuse urine ; deep, snoring 



Ver. vir., opisthotonus. Other remedies: Amm. carb , Amyl. 
nitr., Arsen., Cannab., Cuprum, Curare, Hydr. ac, Hyosc, Ignat., 
Lauroc, Nicotine, Opium, Physostigma. 

Catalepsy 

Is a sudden loss of all voluntary motory power, so quickly befall- 
ing all muscles that the different parts of the body remain pre- 
cisely in the same position in which the attack finds them, thus 
making the patient appear like a statue. At first the muscles 
are rather rigid ; but they gradually grow more pliant, assume a 
waxy flexibility, so that the limbs may be brought into any 
position, in which they continue to remain. The sensibility and 
consciousness of the patient is usually gone ; he perceives nothing 
and recollects nothing; whilst in other cases some sensibility 
seems to remain ; and in still others, sensibility and conscious- 
ness are entirely undisturbed. The patient sees, hears and knows 
everj'thing that is going on around him, but is perfectly unable 
voluntarily to move a single muscle of his body ; the link which 
makes the body an instrument of the soul seems broken. Such 
fits end in simple forms of the disease often quite as sudden as 
they come on. The patient draws a long breath, sighs, yawns, 
and acts as though he was waking out of a deep sleep, and goes on 
with his interrupted work without even suspecting that anything 
has happened to him. Such attacks sometimes follow others at 
short intervals, and they may last only a few minutes at a time. 



892 SPASMODIC DISEASES. 

Graver attacks last hours and days. Skoda mentions one that 
lasted several months. 

Cataleptic spells are frequently combined with hysteria, melan- 
choly, ecstasy, St. Vitus' dance, somnambulism and other nervous 
derangements. The disease is of rare occurrence and its real 
exciting causes seem to be mental agitation, anger, fright, sudden 
joy or fear, grief, disappointment, vexation, ecstasy or religious 
excitements, etc. 

Catalepsy is, by itself, not fatal. 

THERAPEUTIC HINTS.— If caused by anger and vexation, Cha- 
mom., Bryon. 

If caused by fright, Aeon., Bellad., Ignat., Gelsem., Opium. 

If caused by sudden joy, Coffea. 

If caused by grief, Ignat., Phosph. ac. 

If caused by jealousy, Hyosc, Laches. 

If caused by sexual erethism, Platina, Stramon. 

If caused by disappointed love, Ignat., Laches. 

If caused by religious excitement, Stramon., Sulphur and Veratr. 

Epilepsy 

Is characterized by spells of sudden loss of consciousness and 
motor disturbances, under the form of more or less extensive 
convulsions. These spells recur at irregular periods in the 
beginning; the intervals are usually free from morbid symptoms; 
later, however, they are marked by various mental and bodily 
disturbances. The real seat of the disease has been sought in 
the pons and medulla oblongata, although a participation of 
other parts is not denied. Constant anatomical changes are thus 
far unknown, yet, according to the latest investigations, certain 
histological changes in the bulb of the medulla seem to take the 
lead of all the others. 

One of its most prominent Causes is a hereditary disposition, 
developing the disease usually before puberty, or not later than 
the twentieth year. Other occasional causes are: lesions of pe- 
ripheral nerves, of the brain or the spinal cord ("reflex-epilepsy"); 
psychical impressions and emotions, sexual irregularities, digestive 
disturbances, overexertion and great feitigue. In short the list of 
causes is a very large and varied one, and in many instances the 
cause may be as obscure as the nature of the disease itself. 



EPILEPSY. 893 

. The epileptic seizures are in about one-half of the cases preceded 
for a day or two by one or the other, or several of the following 
Premonitory Symptoms: sadness and dejection of spirits, or 
excitement, loquacity, irritableness, quarrelsomeness or distrust; 
dizziness, headache and confusion of the head ; dark coloration of 
the skin of the face and neck (rare); unusual deep sleep and 
general well-feeling, or restless sleep and leaden weight in limbs, 
or slight trembling; voracious appetite, bad smell from the mouth. 

The immediate prodroma or the so-called aura epileptica, which 
must not literally be taken only as a sensation of breath blowing 
upon the patient (scarcely ever recognized), but in the wider 
sense as symptoms which precede immediately the outbreak of 
the fit, and which last but a short time — these immediate pro- 
droma are of great variety. We have a sensitive aura, consisting 
of tickling sensations, or dragging, tearing pains from the pe- 
riphery (tips of toes or fingers) towards the head; one-sided head- 
ache; pains in epigastrium; or loss of feeling in one extremit} r , 
or one-half of the face, taking a centrifugal direction. 

A vasomotor aura consisting of: paleness, coldness and numb- 
ness of one extremity, commencing on the fingers and toes; or 
redness in spots in various parts of the body; a motor aura con- 
sisting of: spasms, trembling or shaking motion of different 
groups of muscles, rumbling in the bowels, straining at stool and 
on passing water, drawing up of the testicle, palpitations, etc. 
The aura of the special senses consists of: impressions of light and 
color, or seeing of corporeal figures; hearing of sounds and voices; 
sensations of disagreeable smell ; sensations of a sweet taste. In 
isolated cases a profuse secretion of tears or perspiration, or an 
abundant flow of saliva has been observed. ' 

Of these various premonitory symptoms in the individual case, 
one or several, or none at all may be present; or the one or the 
other, or several of them may occur repeatedly, without being 
followed by an actual attack. 

The seizure itself is characterized by a loss of consciousness and 
general convulsions. The loss of consciousness is either sudden 
and complete, the patient being stricken down as if by lightning, 
without regard to attitude or surroundings; or a little more 
gradual, tarrying a second or two, so that the patient can assume 
some recumbent position voluntarily, to save himself from injury 
by falling. 

The convulsions are, in rare cases, preceded by a short and 



894 SPASMODIC DISEASES. 

sudden relaxation of all the muscles; generally they commence 
with a tonic spasm, the extent of which is variable, attacking 
either the entire muscular frame, or one-half of the body (opis- 
thotonus, emprosthotonus), or only some groups of muscles, those 
of face, throat and larynx — the unearthly shriek in some cases is 
caused by a laryngeal spasm — or the tonic spasm is wholly want- 
ing, and the scene begins at once with clonic twitchings. During 
the stage of tonic spasm the color of the face is not in all cases 
alike; in some the attack begins with pallor, in others with a 
dark redness of the face, or the color changes from pallor to red- 
ness. All this often lasts only a few seconds, sometimes from 
one-quarter of a minute to one minute. 

The clonic spasm now following, attacks almost all the volun- 
tary muscles of the extremities, trunk and head, and its violence 
is often so great as to cause fractures, dislocations, breaking of 
teeth, deep lacerations of the tongue and rupture of muscles. 
This tumultuous state is at times interrupted by tonic spasms, so 
that the patient again becomes rigid. The face assumes a cya- 
notic color, the eyeballs protrude, and respiration is forcibly 
quickened, and at times arrested. After the lapse of from half a 
minute to three minutes, and only in very exceptional cases still 
longer, the convulsions either stop suddenly, or wear off by 
degrees until the patient lies quiet, with relaxed muscles, in a deep 
coma for some minutes longer, when the turgor diminishes and 
consciousness finally and gradually returns; or the paroxysm is 
immediately followed by a deep sleep, varying from half an hour 
to several hours and longer. After consciousness is fully restored 
the patient feels tired, unnerved, and as if bruised all over, or, in 
lighter cases, he may find himself wholly in his previous condi- 
tion, and without recollection of what has happened to him. 

The light form, Epilepsia mitior, is characterized by loss of con- 
sciousness without any visible outward spasms, or at most accom- 
panied only by fixation of the eyeball. 

The transition forms of epileptic attacks consist of spells with loss 
of consciousness and local spasms. 

The irregular forms of epileptic attach are characterized by spas- 
modic symptoms of a local character with no loss of consciousness 
and sensation, or at the utmost with only a slight confusion and 
obscuration of the senses. Sometimes the spasms are entirely 
wanting, and are replaced by motions of walking and running. At 
other times there are recurring attacks of mental disturbance, such 



EPILEPSY. 895 

as the delirium epilepticum, during which an inclination sets in 
to wander about, or to use obscene language, or to act indecently 
or foolishly. Very serious cases amount to a furious mania, in 
which the patient is driven by an irresistible force to perforin 
acts of violence, to annihilate everything in his reach, to commit 
the most shocking murders, etc. The sufferers often relate after- 
wards that they have had hallucinations of a repulsive and fright- 
ful character. The average duration of this maniacal condition 
may last from two to four days ; it may pass off in a few hours. 

The epileptoid states show themselves like epilepsy, also parox- 
ysmally, and constitute the principal feature of the disease, while 
the symptoms of the intervals are so little pronounced that no 
other nervous or mental affection could be recognized in them. 
Of such the epileptic vertigo is the most frequently occurring and 
the best known. 

The frequency of epileptic paroxysms varies within extremely 
wide limits ; some patients have one seizure a year, others several 
in one day. In many patients the attacks occur principally dur- 
ing the night, with others during the day. So exists also a great 
variety in regard to the forms of the attacks. Some have only 
hard or grave attacks, others only the light ones, while still others 
have all the different forms mingled in alternation. 

The interpdroxysmal condition is characterized most frecmently 
by a weakened memory, by a depression of spirits, by gloominess, 
irritableness, nervousness, distrust and a disposition to get easily 
angered. Patients decline into marked hypochondria or melan- 
choly; the physiognomy and bearing are altered, the lips of the 
patients grow thick, their features coarse, finally assuming the 
expression of imbecility. 

In regard to Differential Diagnosis, I shall mention only 
its simidation. An interesting case was detected by Dr. Mac- 
Donald upon the following grounds : " First, Clegg was a convict, 
sentenced to hard labor, — this furnished a strong motive for 
feigning, and suggested suspicion; second, the occurrence of a 
paroxysm during my visit to the ward; third, the readiness 
with which he spoke of his complaint, and called attention to 
the cicatrices on his face and head ; fourth, the marked change 
in his facial expression when he supposed he was unobserved ; 
fifth, during the spasms the thumbs were not closed within the 
palms, the nails were not livid, muscular rigidity could readily 
be overcome, and the hands, after being forced open, immedi- 



896 SPASMODIC DISEASES. 

ately closed ; sixth, the sphincters were not relaxed ; and, 
seventh, there were no ecchymoses, extravasations, or minute 
petechial spots observable upon forehead, throat, or chest. The 
presence or absence of pallor was not determined by observa- 
tion in Clegg's case, nor was any value attached to the condition 
of the pupils." 

Prognosis. — As bad signs are to be reckoned : attacks which 
come in irregular groups; great frequency of the paroxysms; 
sudden attacks without any premonitory symptoms; vomiting, 
asphyxia, half-sided convulsions, with subsequent paralytic 
symptoms; long-continued coma, delirium, mania, stupidity 
after waking up. 

More favorable signs: short attacks and long intervals between ; 
premonitory symptoms before the attack ; milder convulsions, 
with little embarrassment in respiration ; brief or only partial 
loss of consciousness, and no disturbance of the health in the 
intervals. Still better is it, when the paroxysms become less 
frequent, shorter and milder. The outbreak of cutaneous erup- 
tions and ulcers is quite favorable. In regard to Causes, we find 
it unfavorable when the disease is inherited, or is not cured dur- 
ing the age of puberty, or comes on in middle life, or is caused 
by disorganization of the brain or by continued peripheric irrita- 
tions of the nervous system, like masturbation. More favorable 
are those cases which come on during the period of dentition, or 
are caused by disturbances in the nutritive functions, such as 
chlorosis, anaemia, lead or alcoholic poisoning; in fact, in all cases 
where it is possible to remove the cause. 

THERAPEUTIC HINTS.— Agar., nictitation of the eyelids; itch- 
ing, burning and redness of the fingers and toes, as though they 
had been frozen ; after fright ; suppressed eruptions. 

Amyl. nitr., by inhalation. 

Arg. nitr., in boys with old-looking face; after chewing tobacco. 
Pupils dilated a day or two before the fit. 

Arsen., preceded by a sense of warm air streaming up the spine 
into the head ; vertigo ; loss of consciousness and falling down. 
Afterwards confused and stunned. During the intervals, pressive 
pain in the occiput; burning in the spine; sweet taste in the 
morning; after eating heavy food, burning in the stomach and 
bowels ; stool irregular, mostly diarrhceic, with burning in the 
anus ; also burning in the glans penis during micturition ; fre- 
quent cramps in the calves of the legs. 



EPILEPSY. 897 

Art. vulg., when there are a number of attacks right after each 
other. 

Bellad., the convulsions commence in the arm ; previous, and at 
the time, congestion of the head; throbbing in temples; during 
the attack "the right hand clutches at the throat;" during the in- 
tervals, peevish, angry, scolding, swearing ; or fearful and full of 
anxiety ; vertigo ; growing dark before the eyes ; ringing in the 
ears; headache, with twitching in the face; flushes of heat in the 
face ; red face ; enlarged pupils ; jerking and starting in sleep. 

Bufo, after fright or onanism ; attacks at night followed by 
some hours of coma; loss of consciousness and falling down; 
tonic and clonic spasms ; turgescence and distortion of face ; con- 
vulsive agitation of mouth and eyes ; bloody salivation ; invol- 
untary emission of urine; repeated shocks through the whole 
body; the lower extremities are more in motion than the upper 
ones ; copious perspiration running down the face. 

Calc. ars., pain and oppression in the region of the heart be- 
fore the fit. 

Calc. carb., before the attack: chewing motion with the mouth ; 
stretching of the limbs ; great restlessness ; palpitation of the 
heart ; sense of something running in the arm, or from the pit 
of the stomach down through the abdomen into the feet. After 
the attack: headache; dizziness; sweat on the head ; great thirst; 
canine hunger; vomiting and diarrhoea. During the intervals: 
stupid, peevish ; anxious about getting well ; vertigo ; headache 
before breakfast ; pale, puffed face ; perspires easily, especially on 
the head ; hardness of hearing ; eats a great deal and yet loses 
flesh ; thick, swollen belly; too frequent and too profuse menses; 
swelling of the glands about the neck. Causes: fright; protracted 
intermittent; suppression of chronic eruption. Worse during 
the solstice and full moon; excited by chagrin or fear; by drink- 
ing cold water; by letting the legs swing when sitting. Fre- 
quently indicated after Sulphur. 

Cauloph., epileptiform spasms during or near the menses. 

Caustic, before the attack : imbecility of mind ; heat of the head, 
followed by sweat all over; great pressure in the pit of the stom- 
ach, extending all over the chest and hindering breathing. Dur- 
ing the spell: sometimes bleeding of the nose; very red face; bit- 
ing of the tongue ; drawing the head towards one side ; urine is 
passed involuntarily. Afterwards: soporous condition; headache; 
noise in the head; exhaustion. During the intervals: on the 
57 



898 SPASMODIC DISEASES. 

scalp and glabella small, round, soft lumps ; sweats easily on the 
head; stoppage of the nose ; tongue coated white on both sides ; sour 
or sweetish, badly-tasting eructation, like ink or rotten wood; 
pain in the small of the back, and constant coldness of the shoul- 
ders and joints of the feet ; great restlessness, which urges him 
to run away. Causes: suppressed itch ; protracted intermittent ; 
softening of the brain. Worse during new moon ; drinking cold 
water as soon as the pressure in the stomach commences prevents 
the attack. 

Chin, ars., after the attack cold perspiration, eructations, and 
a feeling of such utter prostration, that the patient believes he 
cannot endure it long. (Payne.) 

Cicuta, epileptiform spasms from venous congestions of the ab- 
domen in children and women. Bluish, puffed face; eyes staring 
upon one point ; electric shocks ; trembling ; difficulty of being 
roused from sleep; small, painful ulcers on the edges of the tongue. 

Cimicif., epileptiform spasms at or near the menstrual period. 

Coccul., for women of great nervous and paralytic weakness, 
with suppressed or very painful menstruation; vertigo with 
nausea. 

Cuprum, before the attack: nausea, retching and throwing up of 
phlegm; bloated abdomen; drawing sensation in the left arm; 
the arm is drawn involuntarily close to the body; formication 
and tearing in the right hand; shuddering; goose-flesh; palpita- 
tion of the heart; or sudden shriek and falling down, without 
any premonitory signs. During the spell: the fingers become 
dead; involuntary discharge of urine; bluish color of the pit of 
the stomach and chest; chest and head covered with perspiration. 
After the spell: weeping; headache; profuse discharge of a clear, 
watery urine; long trembling and shaking of the right hand; 
sleep. During the intervals : anxiety, tendency to be frightened; 
burning in the chest and abdomen, with chilliness of the remain- 
der of the body ; burning and tearing in the small of the hack ; 
numbness of the arms. In clearly idiopathic cases, with no or- 
ganic lesions; worse about new moon; after mental excitement: 
fright, 

Digit, when caused by excessive nightly emissions or onanism, 
with great weakness of the genital organs. 

Gelsem., epileptiform convulsions after suppressed menses, with 
severe spasm of the glottis; epilepsy, with dull feeling in the 
forehead and vertex, and some pain and fulness in the region of 
the medulla oblongata before the attack. 



EPILEPSY. 899 

Glonoin., great congestion of the head and heart; during the 
spasms he spreads his fingers and toes asunder. 

Hyosc, before the attack: vertigo; sparks before the eyes; 
ringing in the ears; gnawing and sensation of hunger in the pit 
of the stomach. During the spell: purple, bluish face; projecting 
eyes; shrieks; grating of teeth; foaming; discharge of urine. 
After the spell: soporous condition, snoring. During the intervals: 
tearing and beating in the right eye, which weeps and seems 
protruded; constipation. Causes: jealousy; disappointed love; 
grief. The attempt to swallow fluids renews the attack. 

Hyper., epileptiform spasms, always after striking the body 
against anything. 

Ignat, epilepsy caused by fright and suppressed grief; espe- 
cially suitable for children. 

Indigo, before attacks : furious, excitable, easily angered ; between 
the attacks : exceedingly melancholic and timid, or gloomy. (L. 
M. Kenyon.) 

Ipec, epileptiform spasms, with shrieks; opisthotonus; pale, 
puffed face and gastric derangements. 

Laches., the patient goes to sleep before an attack, and then is 
seized with a spasm ; creeping sensation from nape of neck down 
the spinal column; giddiness; headache; peculiar feeling in 
throat; bloated stomach and bowels; cold feet. In those cases 
which are caused by onanism, or are in connection with a mor- 
bid excitement of the sexual organs; fluor albus; frequent emis- 
sion of semen; also after jealousy. 

Nux vom., painful spot in the abdomen in the region of the so- 
lar plexus ; pressure upon this spot renews the attack ; during 
interval, constipation ; headache every morning ; no appetite for 
breakfast and nausea after eating. 

GEnanth. croc, recommended by Drs. Davidson and Oehme. 

Opium, nightly attacks ; combined with mental derangements ; 
after the attack long soporous sleep. 

Plumbum, heaviness and numbness of the legs before the spell; 
swollen tongue ; afterivards : long-continued stupid feeling in the 
head, and want of clear consciousness. 

Pulsat, fits before menses ; swelling of abdomen before menses ; 
menses too light and scanty; headache principally over right 
eye ; sensation of a lump rising in throat, which causes nausea 
while eating. (G. W. Cox.) 

Secale, shows toxicologic effects, which hint strongly to it, but 
its sphere of action has not yet been defined. 



900 SPASMODIC DISEASES. 

Silic, before the attack : feeling of great coldness of the left side 
of the body ; shaking of the left arm ; slumber, with starting. 
The spasms spread, undulating from the solar plexus up towards 
the brain; violent screaming; groaning; tears drop out of the 
eyes; foam at the mouth. Afterwards: warm perspiration; 
slumber ; paralysis of the right side ; for scrofulo-rachitic indi- 
viduals; during sleep at night; worse about new moon. 

Stannum, is recommended as one of the most important reme- 
dies, without particular indications; except that its sphere of ac- 
tion is said to have a strong bearing upon the genital organs of 
both sexes. 

Stramon., epileptiform spasms; thrusting the head continually 
in quick succession to the right ; continual rotatory motion with 
the left arm ; pain in the pit of the stomach ; obstinate constipa- 
tion ; deep, snoring sleep ; low-spirited ; fear of death ; desire to 
be alone. 

Sulphur, before the spell: crawling and running as of a mouse 
down the back and arms ; or a sudden feeling as if a mouse were 
running from the right foot up the leg to the right side of the 
abdomen. After the attack, which consists of various convulsive 
motions, he wipes the tears from his eyes ; soporous sleep ; great 
exhaustion ; jerkings in arms and about the mouth in cold air. 
Chronic cases always of psoric taint ; suppressed itch. 

Tarant, during attack squinting of eyes which remain open ; 
afterwards dejection and dizziness for twenty-four hours. 

Ver. vir. and Zizia are likewise recommended. 

Bromide of Ammonium (Kitchen), Bromide of Potassium (old 
school), Cyanide of Potassium (J. Dufty). 

Eclampsia Acuta. 

This is an affection entirely analogous in its external symp- 
toms to epilepsy — sudden loss of consciousness, frequently setting 
in with a shriek ; tonic and subsequently clonic convulsions, 
which are followed by a comatose sleep. But it is entirely differ- 
ent from epilepsy, in that it always accompanies some other mor- 
bid derangement, with the course of which it either ceases, or it 
ends fatally. 

Npthnagel, on the contrary, confines Eclampsia to such cases 
of epileptiform spasms, " which, independently of positive organic 
diseases, present themselves as an independent acute malady, 



ECLAMPSIA ACUTA. 901 

and in which the' same processes arise, generally in the way of 
reflex excitement, and the same mechanism in the establishment 
of the paroxysms comes into play, as in the epileptic seizure itself." 

1. Eclampsia Gravidarum et Parturientium, Puerperal Convulsions. 

Its occurrence is rather rare — one in about five hundred preg- 
nancies, and perhaps less than that. During pregnancy it is of 
a very rare occurrence, and even then is scarcely ever noticed 
before the sixth month. It occurs most frequently during the 
act of parturition, seldom during the lying-in period. Primi- 
parse are most subjected to it, and it sets in mostly during the 
dilatation of the os uteri, or immediately after the expulsion of 
the child. According to Frerichs, it has been observed that such 
women suffer frequently with albuminuria during pregnancy, 
though this is not invariably the case. During the lying-in time 
these convulsions are generally the commencement of inflamma- 
tion of the womb. The attack itself is characterized by the same 
convulsive features as are described under epilepsy. When set- 
ting in during pregnancy, these convulsions generally cause con- 
tractions of the womb and abortus ; when at the beginning of 
labor-pains, they frequently retard the natural progress; but 
when towards the end of parturition, they are apt to hasten the 
expulsion of the foetus. After the birth of the child the contrac- 
tions of the womb generally cease; and this may give rise to 
haemorrhages, retention of the placenta and inflammatory pro- 
cesses of the womb. The convulsions themselves may continue 
for hours afterwards, though they are mostly of less intensity. 
The influence upon the child is, according to Scanzoni, not neces- 
sarily fatal ; about one-half of them are said to die. The later 
the convulsions begin the greater is the chance for the child, and 
vice versa. The Prognosis is doubtful; the earlier they com- 
mence the more so. 

THERAPEUTIC HINTS.— As albuminuria is frequently a fore- 
runner of this terrible complaint, the patient ought to be care- 
fully treated during pregnancy. Compare Albuminuria. 

Atrop. sulph. (Szontagh.) 

Bellad., deep red face ; enlarged pupils; screaming; jerking and 
general convulsions; all which are signs of cerebral congestion 

Chin, sulph., albuminuria; tetanic spasms with loss of conscious- 



902 SPASMODIC DISEASES. 

ness during parturition and afterwards; swollen veins on the 
head and neck; pulse frequent, intermittent and weak. 

Cuprum, during the lying-in time; sour-smelling sweat; miliary 
eruption; anxiety; easily frightened; heaviness of the head; 
soreness of the abdomen to pressure ; burning in the small of the 
back; numbness of the arms. "Spasms commence with cramps 
in fingers and toes; hands and feet turn outward." (Gwynn.) 

Gelsem., during pregnancy, and where there is an ansernic con- 
dition present; protracted labor; rigid os uteri. 

Hyosc, cold perspiration; pale face; suffocating spells and con- 
vulsions during parturition ; facial muscles greatly agitated. 

Ignat, twitching of muscles of mouth and eyes; wild expres- 
sion; eyes upturned; constantly attempting to pull her hair; 
laughing and crying; nervous, excitable. (I. D. Johnson.) 

Laches., the convulsions commence upon the left side of face, 
and continue longer and are more severe about the neck and 
throat than elsewhere. (Minton.) 

Opium, during parturition; cessation of labor-pains; coma; 
retention of stool and urine ; after a fright. 

Platiua, after parturition ; profuse haemorrhage ; yawning ; 
convulsions. 

Stramon., excited, scolding, striking, spitting, crying and laugh- 
ing; face flushed, pupils dilated, in great terror. Spasms; writh- 
ing and floundering in manifold gyrations ; every muscle in play. 
(0. P. Baer.) 

Ver. vir., during parturition; also after blood-letting, during 
the puerperal convulsions, causing furious delirium ; cold, 
clammy perspiration ; turgid and livid face; hideous expression 
of countenance; great activity of arterial system. 

Also compare the hints under the head of Epilepsy. 

2. Eclampsia Infantum, Convulsions of Children. 

By this term is understood convulsions of children, during 
which they lose their consciousness more or less completely, 
which come on in spells, run an acute course and are generally 
connected with some other morbid process. There exists no 
stricter definition as yet. 

Eclampsia attacks by preference boys during the first years — 
stout as well as sickly — especially during dentition. It often 
breaks forth at the commencement of exanthematic fevers, also 






ECLAMPSIA ACUTA. 903 

instead of the chill in intermittent fever; succeeds a sudden fright 
of the mother in the event of her suckling the child immediately. 
It may be caused by fright, fear of punishment, strong light, 
tickling, or violent pain; intestinal irritations from worms, 
indigestible food, such as raisins, cakes, the pulp of oranges, etc. 
These convulsions are characterized by loss of consciousness; 
spasms all over ; congestion of the head ; cyanotic appearance of 
the face, or, in ansemic children, paleness of the face ; snoring ; 
rattling breathing ; sometimes vomiting or involuntary discharge 
of urine and feces. They sometimes follow each other in rapid 
succession and may terminate life unexpectedly in consequence 
of asphyxia; as a rule, however, they yield readily to the 
appropriate homoeopathic remedy. 

THERAPEUTIC HINTS.— Aeon., great restlessness; high fever; 
dry skin, after fright ; from irritation of seat-worms ; from taking 
cold; in consequence of inflammatory affections of the spine; 
during teething. 

Apis, shrieking; boring the head into the pillows; inflam- 
matory affections of the brain. 

Arsen., spasms, preceded by burning heat of the whole body, 
with constant licking of the dry, cracked lips ; wants to drink 
constantly, but little at a time; is hasty in all its motions; grasps 
the tumbler or anything it wants eagerly ; is very restless, with 
anxious expression of the face. 

Bellad., glowing-red, as well as a pale face, with enlarged pupils ; 
great heat in the head; great vascular erethism; drowsiness, 
with inability to sleep ; starting and jerking during sleep ; grat- 
ing of teeth ; especially during dentition ; scrofulous diathesis. 

Calc. carb., the anterior fontanel remains wide open; glandular 
swellings about the neck ; teething process is either very slow or 
else too rapid; much perspiration about the head; greatly in- 
clined to take cold ; hard, swollen abdomen ; rather inclined to 
looseness of the bowels ; often indicated after Bellad. ; one of the 
most important remedies during dentition ; scrofulous diathesis. 

Camphora, ansemic subjects ; coldness of the whole body. 

Chamom., one cheek is red, the other pale ; hot perspiration on 
the head, especially on the hairy portion ; great thirst ; bloated 
bowels ; colicky pains ; greenish discharges ; sour vomiting ; 
constant moaning and groaning; restlessness; the child wants 
to be carried about all the time. During sleep a suspicious work- 



904 SPASMODIC DISEASES. 

ing of the muscles of the face, as if smiling ; during dentition ; 
also, after nursing the breast of a woman laboring under the 
effects of a recent fit of passion. 

Cicuta, especially when the child, without any premonitory 
signs, becomes suddenly stiff, with his eyes fixed upon one point; 
also in violent spasms of tbe head and the upper portion of the 
body; with bluish and puffed face; also in convulsions from 
worms. 

Cuprum, in anaemic conditions ; shrill cries during the attack ; 
drowsy and stupid condition during the intervals, with nausea 
and vomiting of slime ; bloated abdomen, with involuntary, thin 
discharges from the bowels ; also when the child loses its breath 
from crying, and draws its feet spasmodically upwards and back- 
wards upon the nates. 

Cypripedium pub., in the premonitory stage, when there is a 
morbid irritability of the brain, in consequence of which the 
child is very excitable, laughs and plays at unwonted hours ; is 
very wakeful and laughs even in sleep. 

Gelsem., during dentition, with sudden loud outcries ; feverish- 
ness. 

Hyosc, congestion of the head ; bloated and dark face ; protrud- 
ing eyes ; shrieks ; foam at the mouth ; involuntary discharges 
of urine; from fright or fear. 

Ignat, violent convulsions; often tonic spasms predominant; 
nervous temperament; during dentition ; during the commence- 
ment of exanthematic fevers ; after fright, or when children have 
been punished and go to sleep soon afterwards. 

Ipec, pale face; nausea; vomiting; almost always when caused 
by eating indigestible food : raisins, pound-cake, the pulp of an 
orange, etc.; or when the eruption of an exanthematic fever 
strikes in by taking cold. 

Meliloi, during dentition with great congestion to the head. 
(Bo wen.) 

Opium, trembling of the whole body, convulsive motions of the 
extremities; soporous condition with snoring; retention of stool 
and urine; after a fright; or from nursing soon after a sudden 
fright of the mother. 

Platina, in anaemic subjects ; tonic spasm without loss of con- 
sciousness; trismus: pale, sunken lace; after the spell the child 
lies on its back, draws up its limbs and spreads its knees. 

Staunum, renewal of convulsions with the cutting of every tooth; 
also in consequence of worms. 



TREMOR, TREMBLING. 905 

Stramon., congestion of the head ; heat all over the body ; red 
face; spasmodic thrusting of the head in all directions; profuse 
urine ; deep, snoring sleep. 

Sulphur, often when all other remedies fail ; after suppression of 
eruptions; diarrhoea in the morning; during the eruptive state of 
scarlatina. 

Ver. vir., convulsions with opisthotonus; anaemic subjects in 
consequence of diarrhoea. 

Zincum, screaming and starting in sleep ; anxious look when 
getting awake; heat of the body and nightly restlessness; twitch- 
ing and jerking of different muscles, more on the right side than 
on the left; irritable mood; great appetite; bloated abdomen; 
involuntary discharge of urine. According to Kafka, during 
dentition in children with pale blood. 

Tremor, Trembling. 

This affection is of very frequent occurrence, and of various 
forms. Sometimes the head trembles, while the motions of the 
arms go on normally. Some persons tremble during rest as well 
as when in motion; others, only during rest; a majority, how- 
ever, during motion. During sleep all trembling ceases; also 
frequently when in a horizontal position, or in a position in 
which the trembling extremity rests firmly upon support else- 
where. Reflex motions are performed sometimes tremblingly, 
sometimes normally, while all automatic motions almost always 
remain undisturbed. Exertion of the will sometimes aggravates, 
sometimes masters the tremor ; and during intense interest upon 
a subject it may cease entirely. Trembling may be partial, con- 
fined to the upper extremities, or extend over all the muscles, 
so that even the muscles of the face and jaws are involved. It is 
mostly of a transient character ; sometimes part and parcel of a 
disease; sometimes, however, it becomes habitual, chronic, life- 
long. In children, it is found only occasionally, never of long 
duration. Old age is especially subject to it (tremor senilis). 
We find it likewise more amongst women than men. Brain and 
spinal diseases (softening and atrophy) are mostly attended by it. 

It is brought on especially by the vapors of mercury ; lead-poi- 
soning ; opium-eating, and abuse of alcoholic drinks, and tobacco. 
It may be the result of typhus, and an effect of sexual excesses. 
Temporarily it may be caused by mental excitements, overexer- 



906 SPASMODIC DISEASES. 

tions of the muscles, too much coffee or tea-drinking, and too 
low a temperature. To the latter corresponds the trembling dur- 
ing the chilly stage of intermittens. Likewise we find trembling 
easily excited after being tired out, mentally depressed, or ex- 
hausted in any way; and therefore it is frequently found during 
convalescence, after epileptic fits, catalepsy, neuralgia, and dur- 
ing the periods of menstruation and lactation. 

The mercurial tremor greatly resembles paralysis agitans (of 
which next), in its extent, its secondary paresis and the accom- 
panying cerebral and psychical symptoms. The lead tremor is, 
as a rule, limited to the upper extremities and some facial mus- 
cles (orbicularis, levator anguli oris), and is accompanied by nu- 
merous other symptoms of lead-poisoning. The alcohol tremor 
usually begins in the hands, from whence it may spread all over 
the body ; it is worst in the morning during fasting, and allevi- 
ated by the use of spirits. The opium tremor is always associated 
with other opium symptoms, such as contracted pupils, constipa- 
tion, etc.; and the nicotine tremor most frequently attacks only 
one side, or at least one side more than the other, and is gener- 
ally accompanied with various nervous disturbances such as 
muscular weakness, dizziness, neuralgia, myosis, etc. 

THERAPEUTIC HINTS.— Compare multiple sclerosis, paralysis 
agitans. 

Mercurial tremor: Carb. veg., China, Hepar, Laches., Nitr. ac, 
Sulphur, etc. 

Lead tremor: Alum., Bellad., Hepar, Xux vom., Opium, Piatina, 
Stramon., etc. 

Alcohol tremor: Arsen., Ipeo, Xux vom., etc. 

Opium tremor: Bellad., Chamom., Ipec, Mercur., Xux vom.. etc. 

Nicotine tremor: Arsen., Chamom., Coccul., Cuprum, Ignat, Xux 
vom., etc. 

Other tremor: Calc. carb., Cicuta, Mercur., Opium, Plumbum, 
Piatina, Pulsat., Rhus tox., Stramon., Sulphur. 

Thefeelmg of internal trembling: Calc. carb., Iodium, Rhus tox., 
Staphis. 

Paralysis Agitans, Shaking Palsy, 

Consists of a gradually increasing motor weakness and a trem- 
bling in the voluntary muscles of the body, the latter preceding 



PARALYSIS AGITANS. 907 

the paralytic symptoms. In its external manifestation it appears 
as a tremor of high degree; but differs from it by its constantly 
increasing intensity, and by its liability to terminate in paralysis 
and death. 

It commences lightl}', as a feeling of weakness, with slight trem- 
bling of the upper extremities or of the head. The patient is 
still able to execute all voluntary motions, and the trembling at 
first is not constant and may be mastered by the influence of the 
will. In some cases the tremor is limited to only one-half of the 
body, but in others it increases in intensity and becomes a perfect 
shaking of the whole body, by which even the bed upon which 
the patient rests is set in motion. In general the trembling is in- 
dependent of voluntary or passive movements, and by this it is 
distinguished from chorea and from the trembling in dissemi- 
nated sclerosis of the nervous centres. 

Sleep, and easy position, which at first will stop the shaking, 
eventually lose this effect ; and the skin of the patient becomes 
sore in different places from the friction occasioned by the con- 
tinued shaking, which the patient is unable to control. There 
are, however, more or less frequent spells of remission. In some 
cases the patient has an irresistable desire to rum, either forwards 
or backwards, which at first he can resist to a certain degree, suc- 
ceeding in making some uncertain steps on his toes ; but at once 
he falls into a hasty run, until he regains control over these in- 
voluntary motions. At length, however, he cannot walk at all, 
but must be held back from these pitching forward or backward 
motions. 

To all this are gradually added: general exhaustion, great 
sensitiveness of the whole bod} r , paralysis of the voluntary mus- 
cles, difficult deglutition, relaxation of the sphincters, with in- 
voluntary discharge of feces and urine, bed-sores, until, attended 
by the loss of mental capacity and delirium, death relieves the 
patient. 

Its Causes are obscure. It is said to have followed the taking 
of cold and after mental excitements; and its seat is supposed to 
be in the pons and upper part of the medulla oblongata, although 
other autopsies do not sustain this supposition; thus far its ana- 
tomical basis is undecided. 

The Prognosis is unfavorable. 

THERAPEUTIC HINTS.— Compare Arsen., Baryt. carb., Caustic, 
Lycop., Mercur., Phosph. ac, Rhus tox., Stramon., Tarant., Zinc. 



908 SPASMODIC DISEASES. 

Paralysis, Akinesis, 

Is an abolition of the faculty of exciting the normal function of 
the motor nervous apparatus and the muscles. A mere diminu- 
tion of voluntary movableness, attended with a sense of fatigue, 
is termed Paresis. The latter may gradually pass into paralysis. 
Paralysis may arise : 

1. From destruction or functional incapacity of those parts of 
the cerebrum, or of the ganglia at the base of the brain, or of the 
cerebellum, in which volitional impulses are probably converted 
into motor excitations (central paralyses). 

2. From diminution or abolition of the conductivity of the 
motor nerves on any place of their course, from their origin in the 
brain and spine to their terminations (paralyses of conduction). 

3. From abolition of excitability and contractibility of the 
muscles (myopathic paralyses). 

The Causes of paralysis are: wounds, occurring of course more 
frequently in the peripheral nerves than in the brain or spine 
(traumatic paralyses); diseases of parts in the neighborhood of the 
nerves, such as exostoses, caries, aneurisms, echinococci, enlarged 
glands, hernise, tumors, etc.; diseases of the nervous system, such as 
neuritis, myelitis, encephalitis, cerebral and spinal apoplexies, 
softenings, scleroses, tumors, etc.; disturbances of the circulation, 
such as ischamiia, embolism, thrombosis, venous stasis, etc.; 
poisoning of tlie blood by vegetable alkaloids, such as woorare, ergo- 
tine, nicotine, saponine, hydrocyanic acid, camphor, etc., and 
metallic preparations, such as lead, etc.; acute diseases, such as acute 
exanthemata, erysipelas, typhoid fever, cholera, dysentery, acute 
articular rheumatism, diphtheritis; chronic infectious diseases and 
cachexise, such as sj^philis and scrofulosis; catching cold; exhaustion 
of the nervous system, by forced marches, excesses in venere, night 
watching, excessive mental exertion, etc. ; reflex action from some 
primary disease, injury or irritation of the nerves at the periphery 
— reflex paralyses. 

Paralysis may extend over a single muscle, or a group of mus- 
cles; over one-half of the body (Hemiplegia), usually caused by a 
lesion in the brain on the opposite side, though it may also be of 
spinal origin; or over both halves of the body symmetrically, 
commencing usually in the lower extremities and spreading to 
trunk and upper extremities (Paraplegia). 

As concomitant and secondary symjrtoms of paralysis may be men- 



PARALYSIS, AKINESIS. 909 

tioned : relaxation or contraction of the affected muscles; want of 
all reflex and automatic movements, when there is interruption of 
the conduction in the peripheric motor nerves (or when the mus- 
cles are destroyed) ; an increase of reflex activity so long as the 
reflex mechanism is not destroyed ; associated movements in the 
paralyzed parts, in many cases where the paralysis is of centric 
origin above the centre of such associated movements; disturb- 
ances of automatic movements, especially of respiration in lesions of 
the lateral columns of the spinal cord in the dorsal and cervical 
regions ; when the respiratory centre in the medulla oblongata 
is affected, asphyxia is soon produced ; in purely cerebral paraly- 
ses respiration continues undisturbed ; retention or involuntary 
passage of urine or of the contents of the bowels in various forms of 
paralyses ; ansesthesia, if the disease affects a peripheric mixed 
nerve trunk, or when the cause of paralysis affects coincidently 
sensory nerves either in the brain or spine; hyperesthesia of the 
parts and paresthesia (formication, numbness, creeping, burning, 
etc.) in consequence of irritations set up in the neighborhood of 
morbid processes, which cause paralysis ; disturbances of the in- 
tellectual faculties are found only in paralysis of cerebral origin ; 
coldness of the parts with passive hypersemia and cyanosis, espe- 
cially in traumatic paralyses; atrophy of the skin, vulnerability of 
the skin, so that slight exposure to cold, pressure or irritation pro- 
duces sores; deformity of the nails; falling off of the hair on the 
paralyzed limb; atrophy of the muscles and bones; cirrhosis of the 
muscles, and increase of the interstitial tissue; enlargement and hyper- 
trophy of the lymphatic glands. All these trophic changes are 
especially found in traumatic paralyses, less often in spinal, and 
still more rarely in cerebral paralyses. 

The Diagnosis between these three forms may be broadly 
stated as follows: 

Peripheral paralyses are limited to the region supplied by one 
or a few nerve trunks ; they are almost always associated with 
ansesthesia ; reflex, automatic and associated movements are ab- 
sent ; spasms occasioned by central disease do not extend to the 
paralyzed muscles; trophic disturbances, especially atrophy of 
the muscles are well marked at an early date ; absence of all 
signs indicating spinal or cerebral disease. 

Spinal paralyses occur most frequently as paraplegia : attacking 
symmetrical groups of muscles belonging to the lower extremi- 
ties, trunk, belly, and upper extremities, progressively in accord- 



910 SPASMODIC DISEASES. 

ance with the height which the disease has reached in the spinal 
cord (lumbar, dorsal or cervical regions) ; they are frequently- 
accompanied by numbness, formication, etc., in the feet, by pain 
in the back, and a sensation of constriction around the body ; 
they are characterized by incontinence or retention of urine, by 
priapism, pollutions, spermatorrhoea and impotence ; respiration 
is affected only when the corresponding part of the cord is in- 
volved ; myosis in cervical lesions ; convulsive movements pro- 
ceeding from the brain do not extend to the paralyzed parts ; 
trophic disturbances may and may not be present; psychical 
affections and affections of special senses are usually absent. 

Cerebral paralyses, from extravasation of blood, embolism, tu- 
mors, etc., are usually hemiplegia upon the opposite side of the 
bod}- ; sometimes, however, it is limited to particular nerves and 
plexuses; reflex actions are almost always preserved and fre- 
quently increased in energy; associated and automatic move- 
ments are usually unaltered; motor irritation (contractures, 
twitchings and spasms) are not unfrequent in the affected parts ; 
epileptic convulsions occur also in the paralyzed parts ; atrophy 
of the muscles scarcely ever occurs, except in paralysis of the 
pons; psychical disturbances and disturbances of the higher 
senses are quite characteristic, and frequently aphasia (intellect- 
ual) or alabia (peripheric disturbances of speech) occur. Cerebral 
paraplegia is very rare, and generally occurs in the form of two 
separate hemiplegia?, one side being more severely attacked than 
the other. 

Myopathic paralyses commence in particular muscles and grad- 
ually spread to others, frequently from one muscular fasciculus 
to another; they are preceded by atrophy; they are accompanied 
by fibrillar contractions and pain in the muscles, a diminution 
of the electrical excitability, and the presence of a demonstrable 
local cause. 

THERAPEUTIC HINTS.— Aeon., from congestion of spinal cord, 
attended with numbness of the parts. 

Aesc. glab. is recommended for paralytic affections of the lower 
extremities. 

Aesc. hipp., for paralysis of the upper extremities; back and 
legs weak. 

Agar., paralysis of lower limbs with slight spasms of arms; pain 
in lumbar region and sacrum; crosswise affections. 






PARALYSIS, AKINESIS. 911 

Alum, met, paralysis from spinal diseases'; loss of sensibility of 
the feet; inability to walk except with open eyes, and in the day- 
time. 

Anac, after apoplexy; loss of memory; imbecility of mind; 
loss of will. 

Apis mel., one side paralyzed, the other twitching; cerebral 
origin. 

Arg. nitr., paraplegia from exhaustion. 

Arnica, in consequence of exudations within the brain or spine; 
in consequence of apoplexy, of concussions, of weakening diseases, 
of protracted intermittent fevers and ischias. 

Arsen., when associated with great prostration and neuralgic 
pains ; also in spinal affections with gressus gallinaceus, and as 
an antidote to lead-poisoning. 

Baiyt. carb., general paralysis of old age, with loss of memory 
and trembling of the limbs; also after apoplexy in old age, and 
especially in paralysis of the tongue. 

Bellad., apoplexy ; congestion of the head ; paralysis of the one 
and spasm of the other side of the body; paralysis of the face; 
locomotor ataxy. 

Cauloph., paraplegia in consequence of retroversion and conges- 
tion of the womb after child-birth, with partial loss of sensation 
in the affected limbs; considerable emaciation, anaemia and 
general debility. 

Caustic, paralysis of the face or tongue or hemiplegia, with gid- 
diness, weakness of sight, weeping mood; hopelessness; fear of 
death; drawing, lame feeling in the affected part; after exposure 
to severe, cold winds; catarrhal and rheumatic conditions; sup- 
pressed itch or other chronic eruptions; apoplexy. 

China, after great loss of blood. 

Cina, paraplegia with unnatural hunger. (Lounsbury.) 

Coccul., paralysis of face or tongue or pharynx; paraplegia; 
rheumatic lameness; in weakened and nervous subjects, who are 
inclined to fainting fits and palpitation of the heart ; also when 
the paralytic affection originates in the small of the back after 
taking cold, with cold feeling of the extremities and oedema of 
the feet; likewise after apoplexy. 

Colchic, after a sudden suppression of general perspiration, or 
of sweat of the feet by getting wet. 

Conium, paralysis from periphery upwards; old women; humid 
tetters. 



912 SPASMODIC DISEASES. 

Cuprum, after apoplexy, when there is congestion in the chest, 
strong palpitation of the heart, or slow, weak and small pulse; 
the eyelids keep closed and twitch; when opening the eyes, the 
eyeballs move about; paralysis after cholera and typhus; pa- 
ralysis commencing at the periphery and progressing towards the 
centre. 

Curare, nervous debility from loss of fluids or after exhausting 
illness. 

Dulcam., after taking cold, and suppressed eruptions; paralysis 
of the upper and lower extremities, and the tongue; the paralyzed 
arm feels icy cold. 

Ferrum, after great loss of vital fluids. 

Gelsem., loss of motion, but not sensation; paralysis of the or- 
gans of deglutition, and in aphonia, succeeding diphtheria ; loco- 
motor ataxia ; paraplegia. 

Graphii, rheumatic, peripheric paralysis of the face. 

Hepar, after mercurial poisoning. 

Hyosc, after spasms. 

Ignat, after great mental emotions and night-watching in the 
sick-chamber ; hysterical paraplegia. 

Kali carb., trembling ; paralytic weakness, with cramps in fin- 
gers and hand ; also paralytic weakness in the hip-joint. 

Kali phosph., after exhaustion of nerve power, after hysteria. 

Laches., especially left side ; awkward, stumbling gait ; gressus 
gallinaceus ; after apoplexy. 

Mercur., rigidity and immobility of all the limbs, although they 
can be easily moved by others ; indescribable malaise of body and 
soul ; trembling of limbs and body ; paralysis agitans. 

Natr. mur., paralytic condition of the lower limbs ; painful con- 
traction of the ham-strings ; after intermittent fevers, diphtheria, 
sexual excesses, and violent fits of passion. 

Nux vom., incomplete paralysis of the face, arms or legs, with 
vertigo ; weak memory ; darkness before the eyes ; ringing in the 
ears ; loss of appetite ; burning in the stomach ; flatulence ; vom- 
iting after eating and drinking; constipation; especially in 
drunkards ; after apoplexy, mental overexertion. 

Oleand., painless stiffness and paralysis of the limbs ; insensi- 
bility of the whole body ; trembling of the knees when standing, 
and of the hands when writing ; preceded by spells of vertigo a 
long time before paralysis develops itself. 

Opium, paralysis and insensibility after apoplexy ; in drunkards ; 
in old people ; retention of stool and urine. 



PARALYSIS, AKINESIS. 913 

Ox. ac, paralysis from inflammation of spinal cord; limbs stiff; 
paroxysms of dyspnoea. 

Phosphor., paralysis in consequence of spinal affections; after 
sexual excesses; after confinement; tingling and tearing pain 
from the back down into the limbs ; gressus vaccinus. 

Picric ac, after tonic and chronic spasms; on standing keeps 
legs wide apart, looks steadily at objects as if unable to make 
them out ; wasting palsy. 

Plumbum, paralysis complete, with atrophy of the affected parts, 
preceded by trembling ; mental derangement. 

Psorin., after debilitating acute diseases. 

Rhus tox., rheumatic paralytic affections after getting wet, and 
after great or unwonted muscular exertions, strainings, etc.; in 
consequence of t} r phoid processes; with painful stiffness, tearing, 
drawing and aching of the whole body; sometimes with tingling 
and numbness of the parts, or continued cold feet for a long 
time; worse during rest, and when commencing to move, from 
washing in cold water, with every change of the weather; better 
from dry heat near the stove, from continued gentle moving 
about, and flexion of the limbs. 

Ruta, facial paralysis after catching cold. 

Secale, paralysis after spasms and apoplexy, with rapid emacia- 
tion of the affected parts, and involuntary discharges from bowels 
and bladder. 

Silic, paralysis of the left hand, with atrophy and numbness in 
the fingers; paralysis of the legs, always worse in the morning, 
with heaviness of the head and ringing in the ears. 

Staunum, hemiplegia, especially on the left side, with a feeling 
of a heavy load in the affected arm and corresponding side of the 
chest, and frequent night-sweats. 

Stramon., after convulsions; also paralysis of the one and 
spasms of the other side. 

Sulphur, after typhus, exanthematic fevers, suppressed itch or 
chronic eruptions and spasms; also when other remedies seem to 
fail. 

Tarant, numbness and formication and loss of motor power. 

Ziucum, worse after drinking wine; great restlessness of feet; 
after suppressed foot-sweat. 

Besides, compare the following, which are partly taken from 
Jahr: for — 

Paralysis of the eyelids: Arnica, Arg. nitr., Bellad., Canthar., 

58 



914 PARALYSIS. 

Coccul., Cupr. ac, Euphorb., Gelsem., Hyosc, Nitr. ac, Opium, 
Plumbum, Rhus tox., Sepia, Spigel., Stramon., Veratr., Zincum. 

Paralysis of the face: Bellad., Caustic, Coccul., Graphit., Nux 
vom., Opium. 

Paralysis of the tongue and organs of speech: Aeon., Arnica, 
Arsen., Baryt. carb., Bellad., Caustic, Coccul., Cuprum, Dulcam., 
Hepar, Hydr. ac, Hyosc, Laches., Mur. ac, Opium, Plumbum, 
Stramon. 

Paralysis of the organs of deglutition : Bellad., Canthar., Caustic, 
Coccul, Cuprum, Gelsem., Laches., Silic, Stramon. 

Paralysis of the' bladder: Arsen., Bellad., Canthar., Dulcam., 
Gelsem., Hyosc, Laches., Lycop., Natr. mur., Opium. 

Paralysis of the rectum and sphincter ani: Caustic, Coloc, Hyosc, 
Lycop., Opium, Phosphor., Ruta t Zinc, sulph. 

Paralysis of all the limbs: Arnica, Arsen., Colchic, Dulcam., 
Gelsem., Mercur., Nux vom., Rhus tox., Sanguin. 

Paralysis of the upper extremities: Aeon., JEsc. hipp., Arnica, 
Bellad., Calc carb., Caustic, China, Coccul., Colchic, Dulcam., 
Lycop., Mercur., Nitrum, Nux vom., Rhus tox., Sepia, Tart: emet., 
Veratr. 

Paralysis of the hands: Ambra, Arsen., Caustic, Cuprum, Fer- 
rum, Natr. mur., Rhus tox., Ruta, Silic 

Paralysis of the fingers: Ambra, Calc. carb., Cuprum, Natr. mur., 
Secale, Silic. 

Paralysis of the lower extremities: Alum., Arnica, Bellad., Bryon., 
China, Coccul., Colchic, Dulcam., Kali carb., Mercur., Nux vom., 
Phosphor., Plumbum, Rhus tox., Secale, Sulphur, Veratr. 

Paralysis of the feet: Arsen., China, Oleand., Plumbum. 

Hemiplegia: Alum., Anac, Arg., nitr., Arnica, Bellad., Caustic, 
China, Coccul., Dulcam., Graphit., Hyosc, Kali carb., Laches., 
Mercur., Phosph. ac, Plumbum, Rhus tox., Sepia, Stannum, 
Staphis., Stramon. 

Left sided hemiplegia : Arnica, Arsen., Bellad., Caustic, Laches., 
Rhus tox. 

Right sided hemiplegia: Arnica, Bellad., Caustic, Rhus tox. 

Paralysis of one and spasms of the other side: Bellad., Laches., 
Stramon. 

Paraplegia: Coccul., Nux vom., Lauroc, Secale and others. 

Paralysis in consequence of — 

Mental emotions: Arnica, Ignat,, Natr. mur., Stannum. 

Bodily exertions: Arsen., Arnica, Rhus tox. 



INFANTILE WASTING PALSY. 915 

Spasms: Arsen., Caustic, Coccul., Cuprum, Hyosc, Lauroc, 
Nux vom., Plumbum, Rhus tox., Secale, Silic, Stannum, Stra- 
mon., Sulphur. 

Apoplexy: Arnica, Anac, Baryt. carb., Caustic, Cuprum, 
Laches., Nux vom., Plumbum, Secale, Stannum, Stramon., Zinc. 

Taking cold: Arnica, Caustic, Colchic, Dulcam., Mercur., Rhus 
tox. 

Getting wet: Caustic, Nux vom., Rhus tox. 

Suppression of sweat : Colchic. 

Onanism, sexual excesses: China, Coccul., Ferrum, Natr. mur., Nux 
vom., Sulphur. 

Rheumatism: Arnica, Baryt. carb., Bryon., Canthar., Caustic, 
China, Coccul., Ferrum, Gelsem.,Lycop.,Ruta, Sulphur, Tart. emet. 

Intermittent fevers: Arnica, Arsen., Laches., Natr. mur., Nux 
vom., Rhus tox. 

Typhus fever : Coccul., Cuprum, Nux vom., Rhus tox., Sulphur. 

Diphtheria: Arsen., Gelsem., Laches., Natr. mur. 

Cholera: Cuprum, Secale, Sulphur, Veratr. 

Suppressed eruptions: Caustic, Dulcam., Hepar, Sulphur. 

Poisoning by arsenicum: China, Ferrum, Graphit., Hepar, Nux 
vom. 

Poisoning by lead: Cuprum, Opium, Platina. 

Poisoning by mere: Hepar, Nitr. ac, Staphis., Stramon., Sulphur. 

Infantile Wasting Palsy, Essential Infantile Palsy. 

As the name indicates, a disease of childhood, by some consid- 
ered of spinal origin from inflammation in the anterior cornua 
and lateral columns, and terminating in progressive atrophy of 
the muscles affected. 

The attack is often ushered in b)' febrile symptoms of varied . 
intensity and duration (from twelve hours to several days), or by 
convulsions ; or more or less general paralysis sets in suddenly 
without any prodroma. Usually the paralysis localizes itself in 
one or two limbs, or only in some groups of muscles, or attacks 
limbs and trunk together, but never the head nor the sphincters. 
The intellectual faculties remain unimpaired. The affected mus- 
cles soon become flaccid and flabby, and the ligaments relaxed. 
In about two weeks or thereabout the wasting of the muscles 
shows plainly, especially on the legs, arms and shoulders ; the 
bones grow thinner; the diseased limb ceases growing. The 



916 SPASMODIC DISEASES. 

skin appears tough, cool, of a bluish color, and frequently some- 
what cedematous. The relaxation of the ligaments in conjunc- 
tion with the contraction of remnants of sound muscles causes 
subluxations and luxations of the joints, so that deformities, like 
club-foot, genu varum, etc., are of frequent occurrence. 

With all this, sensation remains normal, or in some cases it is 
heightened to hypersesthesia. 

Improvement often takes place and usually the arms recover 
their power quicker than the legs. 

THERAPEUTIC HINTS.— Compare Paralysis and Spinal Diseases. 

Aeon., if the disease commences with the peculiar Aconite fever. 

Bellad., Calc. carb. and phosph., during dentition. 

Phosphor., fatty degeneration of the muscles. 

Sulphur, Psoriu., if there is any psoric taint. 

Thuja, after vaccination. 

Besides : Arsen., Caustic, Coccul., Gelsem., Plumbum, Secale. 

Hydrophobia, Lyssa, Rabies. 

"Hydrophobia in the human subject is an acute infectious disease, 
produced by a specific virus, which is inoculated almost without 
exception, by the bite of a rabid animal (dog, wolf, fox, cat, skunk, 
horse, ox, etc.), most frequently that of the dog. Infection from 
man to man may be said practically never to occur." (Bollinger.) 
Neither is it known that the consumption of the meat or milk of 
rabid animals ever produced the disease ; but numerous observa- 
tions make it quite probable "that dogs may, by their bite, pro- 
duce hydrophobia in the human subject, even during the period 
of incubation of the disease." (Bollinger.) A wound from the 
bite of a dog should, therefore, always be considered with suspi- 
cion ; but instead of killing the dog on the spot, as is frequently 
done by ignorant people, he should be put under strict surveil- 
lance until it is proved whether he was mad or not. This will 
remove, in many cases, the fear and anxiety of those concerned; 
for the bite of a mere vicious dog cannot produce hydrophobia. 

And it ought also to be stated here, that not -everyone who is 
bitten by a mad dog, must necessarily become ill and die of hy- 
drophobia. "Out of 855 human beings bitten by rabid dogs, 299 
(or nearly one-half) cases ended fatally. But if we include also 
the bites of dogs suspected of being rabid, the proportion becomes 



HYDROPHOBIA, LYSSA, RABIES. 917 

decidedly more favorable, 8 per cent, only of those bitten becom- 
ing ill and dying. Out of 1,3G2 human beings that had been 
bitten by rabid dogs, and dogs suspected of being rabid, there 
occurred 105 fatal cases. How great an influence is exerted upon 
this final result by individual predisposition, or by other factors 
which are accidentally brought into play at the time of the bite 
(clothing, deposit of the saliva upon the garments, the extent of 
the haemorrhage, the nature and location of the wound), is diffi- 
cult to determine." (Bollinger.) 

The nature of the wound may be very trifling : a mere abrasion 
of the skin, capable of absorbing the virus, may be sufficient for 
a fatal termination. Large wounds have been considered less 
dangerous than small ones, because the virus, it is said, is more 
easily washed out by the flow of blood ; but with this, facts do 
not agree. In regard to their location, wounds in the face are 
the most dangerous, next, those on the hands and on the body, 
lastly, those on the lower and upper extremities. 

The wounds usually heal readily, with a striking absence of any 
inflammatory tendency, and then follows the period of Incubation 
which varies greatly in length. It seldom is less than two weeks, 
most frequently lasts from three to six months, and in extremely 
rare cases two } r ears and more. During all this time the persons 
bitten feel for the most part quite well, only of some it is said, 
that touching the scar produced peculiar sensations, such as 
shuddering, feeling of anxiety, and sighing. 

The Premonitory Symptoms are in many cases very little 
characteristic. The original wound usually is presented by a 
mere scar, and becomes in exceptional cases only inflamed and 
swollen, and of a reddish or bluish hue. At times tearing pains 
proceed from the wounded parts, or peculiar sensations, such as 
prickling, boring, or burning. In some cases little blisters have 
been observed under the tongue. The patient loses his appetite, 
complains of headache, and becomes depressed and gloomy, and 
then again ill-natured, apprehensive, excitable, and agitated by 
an indescribable feeling of anxiety, especially when he himself 
refers his bad feelings to the bite as the cause. He speaks of it 
and its impending fatal result in a remarkable quick and sharp 
manner. He now becomes sleepless and restless, and the ominous 
symptom of aversion to fluids, and great sensitiveness to every breath 
of air and reflection of light, is the beginning of the 

Second stage, the stage of hydrophobic spasms. However, it 



918 SPASMODIC DISEASES. 

should be stated that this stage in some cases sets in abruptly, 
without any precursory symptoms, with a sudden inability to 
drink, which is soon followed by general convulsions of a paroxys- 
mal character, or brought on by an attempt to drink water, by a 
sudden fright, or by any agitation. 

The inability to drink depends upon peculiar spasms of the 
muscles of deglutition, induced by an attempt to drink, or by the 
mere sight of water or glistening objects, so that after a while, 
notwithstanding the most intense thirst, the patient will rather 
endure the latter, than be subjected to these agonizing spasms — 
hydrophobia. With it are associated spasms of the muscles of re- 
spiration, induced by a draught of air, or by the opening and 
closing of a door — aerophobia — which cause dyspnoea and a feel- 
ing of suffocation, sighing and groaning respiration, and the ut- 
terance of shrill, inarticulate sounds, resembling almost the 
hoarse bark of a dog. The general convulsions appear with 
variable degrees of intensity, from slight muscular contractions, 
trembling of the limbs, to the most severe convulsions of a clonic 
character, less frequently amounting to tetanic convulsions. 
These paroxysms are sometimes associated with maniacal raging 
and hallucinations, which the patient vents upon those around 
him, by abusing them and snapping at them. They are of vari- 
able duration, lasting from one-half to three-quarters of an hour. 
However, in exceptional cases they are absent, and the patient is 
able to swallow fluids, although the act is accompanied by pain. 
In some cases drinking succeeds when the patient is left alone, or 
when he closes his eyes, and uses the aid of a straw. So also are 
warm drinks, such as milk, soups, also wine often more easily 
taken than water. But in most cases the swallowing is impos- 
sible for fluids as well as for solids. 

The paroxysms are followed by periods of rest of equally vari- 
able duration, during which the patient recognizes his surround- 
ings, and answers questions correctly; but his voice is suppressed, 
and he appears extremely apprehensive, or talkative, and is in 
most cases sleepless. At other times an intellectual disturbance 
continues even during the absence of the spasms, and the patient 
sees objects which are not present, or imagines that his sufferings 
are caused by those around him, and he consequently rages and 
defends himself against these imaginary attacks and insults. 

The face of the patient is red, and expresses the greatest mental 
and physical misery and the most horrible agony. The eyes are 



HYDROPHOBIA, LYSSA, RABIES. 919 

wild, rolling, staring and livid; the eyeballs are injected, the 
pupils dilated, and the retina exceedingly sensitive to light. In 
some cases the face is pallid and cyanotic and the expression 
stupid. 

The mouth is full of viscid saliva which, as it can not be swal- 
lowed, is constantly discharged, or incessantly ejected in all di- 
rections. The tongue usually is moist and clean, at times slightly 
coated, seldom dry and thickly coated. The thirst is excessive, 
and accompanied by burning pains in the throat. The appetite 
is usually not affected. There is constant distress in the precordial 
region and dyspnoea ; the bowels are constipated, and the urine is 
scanty, dark colored, cloudy, and frequently contains sugar, but 
no albumen. The temperature usually rises to 100.4° F., seldom 
to 105 or 106° F. The skin is generally moist, and even covered 
with perspiration. During the paroxysms the extremities are 
cool and livid. After this paroxysmal stage, which may last from 
one and a half to three days, follows 

The third stage, or the stage of paralysis, into which the patient 
sinks gradually, if he be not carried off suddenly during a hy- 
drophobic paroxysm. Then the convulsions become more feeble 
and cease entirely ; the muscles still continue to twitch ; the pupils 
are contracted, or are of unequal size ; the eyes are fixed, and 
strabismus frequently appears; "the saliva is no longer ejected, 
but runs from the open mouth; the voice becomes harsh and 
weak, the breathing short and rattling, and the pulse very small, 
irregular and rapid ; the skin is covered with a clammy perspira- 
tion." (Bollinger.) In some cases priapism with frequent semi- 
nal emissions has been observed. 

Towards the last many patients are again enabled to drink 
without any difficulty, "and this was considered of old to be a 
sure sign of death. Death itself may take place amid convul- 
sions, or from asphyxia. It may also approach quietly, seldom 
with symptoms of coma or suffocation." (Bollinger.) This last 
stage lasts, as a rule, only from two to eighteen hours. 

The most prominent morbid anatomical changes found on post- 
mortem examination are : hyperemia of the brain and its mem- 
branes, also of the spine and its membranes, of the lungs, and of 
the kidneys. The sinuses and peripheral veins are generally 
distended with dark colored blood, only slightly coagulated. 

Upon microscopic examination, Klebs found: "In all the 
swollen portions of the lymphatic system, and particularly in 



920 SPASMODIC DISEASES. 

the submaxillary gland, a deposit of finely granular, strongl\ r re- 
fractive corpuscles of a faint brownish color, closely packed to- 
gether in clusters, at some points in the form of a long row, and 
at others branching out so as to form large star-shaped figures, 
following in general the course of the blood-vessels." Whether 
these corpuscles will prove to be the vehicles for the transfer of 
the specific infecting material, is as yet undecided. 

We can now more easily form an opinion as to the value of 
the old, but frequently renewed view, that hydrophobia in man is 
simply an affection of the nerves, which may he induced by anxiety 
and excitement; that it is a simple myth. This imaginary origin 
and essence of hydrophobia is sternly rebuked by the sad fact 
that so many persons, among all nations, succumb to the dreadful 
malady every year. If these persons were only hysterical women 
or hypochondriacal men, there might be some show for such an 
assertion, but the virus if once implanted, spares neither child- 
hood nor age. 

That it is a simple neurosis, a traumatic tetanus, is contradicted 
by the fact that hydrophobia has nothing common with trau- 
matic tetanus. According to Rose, these are the diagnostic 
points of difference between the two: "In traumatic tetanus a con- 
tinuous spasm is present, to which there is finally added an in- 
creased reflex excitability; consciousness remains clear until the 
death-struggle ; the organs involved in the act of swallowing are 
generally unaffected ; the tetanic spasm begins in the masseter 
muscles and in those of the cervical region ; the disease is fatal 
only when it breaks out within a few weeks after the injury. In 
rabies, on the other hand, clonic convulsions occur; reflex con- 
vulsions are noticeable from the outset; loss of consciousness 
often ensues at an early stage ; the masseter muscles and those of 
the neck are not affected by the spasms; the disease makes its 
appearance after a period of incubation, lasting often for months ; 
its course is uniformly acute ; its termination fatal: its promi- 
nent feature consists of an affection of the organs involved in the 
process of deglutition." 

The Prognosis is a grave one. 

THERAPEUTIC HINTS.— Prophylaxis. 

" While in cases in which Cauterization is resorted to, scarcely 
33 per cent, of human beings bitten by rabid animals fall vic- 
tims to the disease; in cases where this operation is not practiced, 



HYDROPHOBIA, LYSSA, RABIES. 921 

exactly 83 per cent, of those bitten encounter certain death." 
(Bollinger.) Brefeld gives the following direction: "After the 
wound has first been syringed out with warm water, it is to be 
gently and thoroughly bathed and cleansed by means of soap- 
suds and a sponge, or with a solution of potash. The wound is 
next to be cauterized by means of caustic potash, and for several 
succeeding weeks (from four to six) a suppuration of the cauter- 
ized wound is to be kept up; a simple ointment, like resin cerate, 
being used as a dressing, or compresses saturated with a two- 
grain solution of potassa. Whenever cicatrization proceeds too 
rapidly, the cauterization by means of a strong solution of po- 
tassa is to be repeated." 

"The application of suction to the wound, either by the mouth of 
the sufferer, if the position of the wound permits, or by some 
other person, constitutes decidedly one of the most efficient measures, 
and one that can always he applied upon the spot." (Bollinger.) It 
is self-understood that the lips of the operator should be entirely 
free from any cracks or wounds. Instead of the mouth, the dry 
cupping-glass may be applied, where the seat of the wound per- 
mits it. 

"The best remedy," says Hering, "is heat applied at a sufficient 
distance to prevent actual scorching of the wounded part." Take a 
hot iron, a live coal, or even a burning cigar, and hold it so near 
to the wound and its circumference that the patient feels the heat 
strongly, and continue until he commences to shudder. It is 
well to apply oil or fat around the wound, and necessary that all 
moisture which oozes from the wound should be carefully wiped 
off. This ought to be repeated three or four times daily, for one 
hour, until the wound has healed. 

So may also the Turkish bath be of great use. 

There are a number of remedies, and among them a number of 
secret preparations used as prophylactics. 

Hahnemann recommends Bellad. in the smallest dose, at first 
repeated every third or fourth day, and later at longer intervals. 
"William Gross, Hering, and Hartmann have also recommended it. 

Hydrophobia, or Lyssin has been introduced by Hering, and its 
provings show its adaptedness to such cases. 

Canthar 15 ., has been found effective by Hartlaub and Trinks. 

Anagallis arvensis and Meloe majalis are popular remedies. 

The developed malady requires first of all " the removal of every 
cause of excitement; the separation of the patient from every- 



922 SPASMODIC DISEASES. 

thing calculated to disturb or render him anxious ; the maintain- 
ance of the utmost quiet; the employment of a friendly tone of 
address (in place of coercive measures) ; and the endeavor to calm 
the sufferer by kind treatment." (Bollinger.) 

Bellad., congested face; wild staring look; pupils dilated; sen- 
sitiveness to sunlight or shining things ; throat sore ; spasms of 
throat ; hoarse, barking voice ; inability to swallow ; oppression ; 
anxiety ; hallucinations ; biting and snapping ; convulsions. 

Canthar., when swallowing is prevented by inflammation, and 
not only from spasms of the throat; spasms follow the pain 
caused by swallowing; also when there is priapismus. (Hart- 
mann.) 

Hydrophobin. or Lyssin, when the wound becomes bluish-red, 
with edges hard and swollen. (IJering.) 

Hyosc, general convulsions more prominent than spasms of the 
throat ; does not spit and snap at those around, but abuses them 
otherwise. Sleep is interrupted as if by a sudden fright, followed 
by convulsions. After the abuse of Bellad. in massive doses. 

Laches., in the worst state of the developed disease it may be 
better than any other remedy. (Hering.) 

Spiraea ulmer., during a frantic paroxysm a patient devoured 
with eagerness a piece of the root of this plant. One-quarter of 
an hour after, he became conscious, vomited gall and fell into a 
profound sleep for 24 hours. He was well afterwards. (Kuhner, 
in Med. Journal, Vol. VII, p. 51, Russia.) 

Stramon., Hahnemann says "that according to the totality of 
the s3^mptoms of a given case, it may be indicated as well as 
Bellad. or Hyosc." Characteristics appear to be the fear of im- 
aginary objects, and the great mobility and restlessness, with 
screaming. 



THE BLOOD 



This being the fluid which nourishes all parts of the system, 
which sustains respiration, which, in short, is the life of the body, 
must necessarily cause great disturbances of the body when it 
becomes in any way abnormally changed. The blood consists of 
corpuscles and serum. The corpuscles are of two kinds — red, and 
colorless or white. The serum contains water, fibrin, albumen, salts, 
fatty substances and extractive matters. 

Any of these constituents may be abnormally increased, de- 
creased, or altered, causing an abnormal condition in the quality 
of the blood. 

The whole mass of the blood may be increased or decreased, 
causing an abnormal quantity. Obnoxious substances, like sugar, 
uric acid, oxalic acid, ammonia, sulphuretted hydrogen, urates, 
gall, pus, may be mixed with, and thus may impregnate, the 
blood, causing a poisoned state of the whole fluid. 

It is only within the last ten or twenty years that these differ- 
ent changes of the blood have been made the subject of closer 
examination, and much of it requires still closer investigation. 
I shall, therefore, confine myself to the most important facts which 
these researches have brought to light. 

1. Cyanosis. 

The blood-corpuscles absorb the oxygen, with which they come 
in contact during their course through the lungs. Any cause which 
prevents this absorption of oxygen by the blood-corpuscles hin- 
ders the transformation of the venous into arterial blood. This is 
the nature of cyanosis. It consists in a decreased absorption of 
oxygen by the blood-corpuscles. Its Causes are numerous, and 
may be arranged under the following heads : 



924 BLOOD. 

1. Imperfect respiration, in consequence of spasms, or oedema, or 
croupous inflammation of the glottis and larynx; or in conse- 
quence of obstructions within the trachea and bronchial tubes, 
caused by spasms, mucus, blood, foreign bodies, false-membranea' 
or in consequence of obstacles which prevent the air from enter- 
ing the air-cells of the lungs, caused by infiltration, hepatization, 
exudation (emphysema, hydrothorax, pneumothorax); or in 
consequence of paralytic affections of the respiratory muscles and 
diseases of the abdomen, by which the lungs become compressed; 
enlargement of the abdominal organs, tympanites, ascites, etc. 

2. Imperfect circulation, in consequence of heart disease, ob- 
structions within the pulmonary vessels, obliteration of the pul- 
monary tissue and blood-vessels, immediate transmission of the 
venous blood into the left ventricle, in consequence of the non- 
closure at birth of the foramen ovale. 

3. Inhalation of air, which contains too little oyxgen, and is 
impregnated with irrespirable gases, like carbonic acid gas, etc. 

4. Inability of the blood-corpuscles to absorb oxygen. This has 
been observed in some severe illnesses, such as typhus, pyaemia, 
and in the last stage of pulmonary tuberculosis; cholera. 

Symptoms. — Bluishness of the surface of the body, especially of 
the face and lips; coldness of the extremities and depression of the 
muscular and nervous system; sopor; in a still higher degree, 
asphyxia. 

Cyanosis is, therefore, not a disease in itself, but a mere conse- 
quence and symptom of other derangements; still as a symptom 
it has, nevertheless, some therapeutic value, suggesting Aeon., 
Amm. carb , Arnica, Arsen., Camphora, Carb. veg., Conium, Cuprum, 
Digit, Laches., Opium, Pulsat., Rhus tox., Sambuc, Sec. carb., Veratr. 

In new-born children, where the foramen ovale has not closed, 
Laches. 

2. Dissolution of the Red Blood-Corpuscles. 

Each blood-corpuscle lives a certain period of time, and after 
that it dissolves and disappears and new ones form in its place. 
Thus a constant rotation between life and death goes on in these 
minute bodies in order to sustain the life of the whole body. In 
disease, however, this equilibrium is sometimes destroyed; more 
corpuscles die than are generated, and this causes a state of the 
blood which is called Oligocythemia. It is characterized by weak- 



LEUKiEMIA. 925 

ness of the muscular system, tired feeling all over; nervousness, 
palpitation of the heart, bellows-sounds of the heart and large 
arteries; murmur in the jugular veins. 

In still other cases the dissolution of the blood-corpuscles goes 
on so rapidly and to such an extent that the blood-serum becomes 
overloaded with the constituents of the destroyed corpuscles, and 
is thus discolored. Even the excretions of the body assume a 
bloody or dark appearance; and the exudations are of a brown- 
ish, or still darker hue. The skin and mucous membranes 
become tinctured with haematin (the coloring matter of the blood), 
and color it yellowish, which may be mistaken for jaundice. 

If such a profuse dissolution of blood-corpuscles is confined to 
a certain portion of the circulation, it constitutes an essential part 
in what is called Local Gangrene. A general putrid dissolution 
through the whole system is General Gangrene, Septicaemia. We 
find such states of general dissolution in some forms of typhus, 
scurvy, puerperal fevers, yellow fever, and various other forms 
of tropical fevers. By what it is caused, we do not know. 

Compare Alum. P. S., Arsen., Carb. veg., China, Laches., Nitr. 
ac, Secale. 

3. Leukaemia. 

" The number of the colorless cells is so much increased that 
the blood has a whitish color," that is, under the microscope. 
Virchow thought, by finding this state of the blood in some cases, 
he had discovered a new disease. And as, according to his ob- 
servations, the predominance of the white corpuscles appeared in 
connection with enlargement of the spleen and tumors of the 
lymphatic glands, he distinguished two forms of leukaemia, the 
splenic and the lymphatic. To this has recently been added a 
third form, Neumann's myelogenous leukaemia, which is presumed 
to have its starting point in the bony marrow. 

The patients complain, long before any increase of the white 
cells in the blood can be discovered, of prostration, dislike to 
work, dull pains in the splenic region, headache, dizziness, ring- 
ing in ears, palpitation, shortness of breath, enlargement of the 
lymphatic glands in various parts of the body, but especially in 
the cervical, jugular, axillar, and inguinal regions'. However, 
there are cases of considerable tumors of the spleen and lym- 
phatic glands without leukaemia. 



926 BLOOD. 

This "new" disease of Virchow has been, well known and 
studied in all its features (except the accumulation of the white 
blood-corpuscles), by the older physicians, under the name of 
Sycosis, who considered it as the effect of a contamination with 
gonorrhoea! poison, while Virchow and his followers saw the 
cause in the surplus of white cells — without explaining the cause 
of this accumulation, which, as stated before, is often not present 
until at a late period of the disease. Thus, instead of having dis- 
covered a new disease, Virchow has found merely a new symp- 
tom of an old disease. Compare Von Grauvogl upon this subject 
in his great work, " Lehrbuch der Homoeopathic" 

THERAPEUTIC HINTS.— Grauvogl recommends Natr. sulph. and 
Thuja as the main remedies. 

Other remedies, however, especially those of the hydrogenoid 
order, may likewise be indicated by special symptoms, such reme- 
dies are : Natr. nitr., Natr. carb., Natr. acet., Kali nitr., Calc. carb., 
Magn. carb. and phosph., Silio, Iodium, Bromium, Chlor., Nitr. ao, 
Natr. mur., Borax, Antimon., Alum., Carbo veg., Arnica, Aranea 
diad., Pulsat., Nux vom., Ipec, Arsen., Conium, Apis, Spigel., 
and animal food. 

4. Hydraemia 

Consists in a decrease of albumen and an increase of water in 
the serum sanguinis. In consequence of this the serum is much 
more prone to exudation than in its normal state, and we there- 
fore find this state of the blood frequently associated with dropsi- 
cal effusion*. 

Its Causes may be: — 

1. Long-continued pathological secretions of clear albumen, or albu- 
minous substances (mucus, milk, etc.); in consequence of albumi- 
nuria, serous diarrhoea, pus-formation, exudation, loss of blood, 
mucous discharges, too copious flow of milk, too long-continued 
nursing. 

2. Insufficient supply of nutriment or disturbed nutrition, so that 
the received nourishment is not converted into albumen and as- 
similated. Hydrsemia is therefore found in connection with the 
most different morbid processes. We find it in combination 
with diseases of the heart and lungs, especially tuberculosis, 
chronic indigestion, protracted intermitting fevers, Bright 's dis- 
ease, etc. 



PLETHORA — ANiEMIA, OLIGEMIA. 927 

THERAPEUTIC HINTS must be referred to the above-named 
morbid conditions. 

5. Plethora. 

The quantity of the blood must always be estimated as a rela- 
tive mass. We cannot say, so much is just enough, one ounce 
more is too much. And in fact during life we have no means 
for such estimation. The whole plethoric theory therefore rests 
rather upon a weak foundation. On the other hand, if we ob- 
serve different individuals, it seems clear enough that some are 
richer in this vital fluid than others. And as objective signs, 
which indicate such repletion, are stated: 1. A higher degree of 
redness of the body — such higher color, however, may be often 
very fallacious ; it is of any account only when it is perpetually 
so; and, 2. The greater fulness and repletion of the circulatory vessels, 
arteries and veins. This is plethora of olden times. More recent 
observers have split this theory into three branches. 

They divide plethora of old into — 

1. Plethora vera, true plethora, which is said to characterize itself 
by fulness of the arteries and veins, repletion of single organs, 
florid complexion and increased temperature of the body. 

2. Serous plethora, an increase of blood-serum, and decrease of 
corpuscles, which characterizes itself by fulness of the arteries 
and veins, paleness, or else quick change of color ; and, 

3. Plethora ad vasa, or false plethora, which is not too much 
blood in general, but too great an afflux of blood into the blood- 
vessels, as in fevers, in consequence of bodily and mental exer- 
tions, spirituous, irritating drugs, etc. 

All these distinctions are of little use for Homoeopathic prac- 
tice, as the Homoeopathic physician will scarcely have occasion 
to trouble his brain with the question : Shall I bleed ? or shall I 
not? 

6. Anaemia, Oligemia. 

The first denotes a want, the latter a poorness of the blood ; the 
exact pathological meaning is a diminution of plasmatic albu- 
minates, of red corpuscles and of water in the blood ; changes in 
quality and quantity of other blood-constituents are of minor con- 
sideration. 



A sudden loss of blood by haemorrhage (internal or from wounds), 
although producing a state of anaemia, and in consequence thereof, 
perhaps general epileptiform convulsions, loss of consciousness, 
delirium, hiccough, retching, vomiting and death, does not ex- 
actly belong here. We mean to consider the subacute and chronic 
forms of anaemia, the Causes of which are exceedingly various. 
They may consist of: deficient supply of food, a want of light 
and air, too little or too much exercise, too high or too low tem- 
perature, excessive losses of semen, too long continued lactation, 
profuse menstruation, great care or grief, or mental overwork, 
albuminuria, blenorrhoeas of the different mucous membranes, 
diarrhoea and dysentery, extensive suppurations, large effusions 
in the pericardial, pleural or peritoneal cavities, infiltrations into 
the lung tissues, malignant growths, malarial infections, mineral 
poisonings (acids, phosphorus, etc.), animal parasites, especially 
the anchylostomum duodenale (compare the chapter on Intestinal 
Worms), indigestion, diseases of the spleen, lymphatic glands, etc., 
and fever. 

The Symptoms of anaemia are : paleness of the skin and mucous 
membranes, dropsical effusions in consequence of the diminished 
albumen in the blood, emaciation, marasmus or general atrophy 
of the tissues, a tendency to degenerative processes and haemor- 
rhages, and a decrease of the normal temperature down to 95° F., 
and lower ; muscular exhaustion, irritable weakness, anaemic 
murmurs over the region of the heart, and the " Xonnengeraiisch *' 
or " bruit de diable," a continuous humming sound over the in- 
ternal jugular veins, dyspnoea. 

The Duration and Prognosis of anaemia depends altogether 
upon its causes to which it owes its origin. 

Progressive Pernicious Ansemia, 

Also known under the names of essential malignant and essential 
febrile anaemia, includes those cases of extreme anaemia which 
tend uninterruptedly towards a fatal issue, and of which no ade- 
quate cause can be discovered, either in the patients' circum- 
stances or in the previous state of their constitution. Its pa- 
thogeny and causes are shrouded in utter obscurity. It attacks 
most frequently women from the age of twenty to that of forty, 
and the cases described and classed under this new term by 
Biermer and Gusserow have principally been observed in Switzer- 
land. Most cases were those of pregnant women. 



PROGRESSIVE PERNICIOUS ANAEMIA. 929 

The Symptoms begin insiduously with a gradual paling of the 
skin and mucous membrane, increasing to a degree as found in 
acute anaemia from hemorrhage. A wasting of the tissues (maras- 
mus) is usually not observed until fever sets in, but other symp- 
toms of anaemia associate early with the increasing paleness. 
Such are : palpitation of the heart ; a loud, blowing, systolic murmur 
and purring tremor over the heart, and the venous hum in the 
jugular veins, characterized by great constancy and intensity ; 
irritable weakness and great prostration with severe fainting fits 
from slightest exertion ; dyspnosa, is hardly able to speak above 
her breath ; effusion into the pericardium and pleura, and puffi- 
ness of the legs ; hsemorrhages from different parts of the body : 
the nose, gums, genital organs in women, and the skin in the 
form of petechia? and occasionally as large patches of ecchy mosis ; 
hseinonhages in the retina and other internal parts. The fever 
is of an irregular type, with temporary exacerbations, when the 
temperature may run up to 104° F. As the end approaches it is 
prone to fall suddenly as low as 95° or even 93.2° F. When oc- 
curring during pregnancy, it usually induces premature labor, 
and this is the forerunner of death. 

With all these severe symptoms, Physical Examination 
shows no organic disease of the heart, nor of the kidneys (no al- 
buminuria), nor of the spleen, liver or lymphatic glands, and 
microscopic examination reveals no disproportion in the relative 
number of red corpuscles and leucocytes, thus distinguishing this 
disease thoroughly from leukaemia. From chlorosis it differs by 
its dropsical symptoms and its haemorrhagic diathesis, and from 
other forms of anaemia by its fever. 

The duration of the disease is seldom less than six or eight 
weeks, and seldom more than the same number of months. " Our 
present experience justifies us in regarding every case as tending 
inevitably to a lethal issue." (Immermann.) 

THERAPEUTIC HINTS.— In any case of anaemia we must, above 
all things, well weigh its cause or causes, which see above. As a 
mere sj'mptom anaemia may hint to the one or the other of the 
following remedies: Arsen., Calc. carb., Garb. A*eg., China, Cup- 
rum, Ferrum, Helon., Hydrast., Kali carb., Natr. rnur., Nux vom., 
Sulphur, Veratr. and many more. 



59 



930 BLOOD. 

7. Chlorosis. 

According to the latest researches chlorosis seems to be charac- 
terized by a diminution in the amount of haemoglobin in the blood ; 
the change appears to be strictly limited to the red corpuscles. But 
whether this change consists in a diminution of their number, or 
of the proportion of coloring matter contained in the individual 
eorpuscles, is not yet decided. The albuminates and leucocytes 
seem not to be affected, and this is an important pathological dis- 
tinction between it and ansemia, in which latter there is always 
a decrease of the plasmatic albuminates. 

The disease is almost entirely limited to the female sex, between 
the fourteenth and twenty-fourth years of life; it is especially, 
therefore, a disease of the age of female puberty, seems often to 
grow upon a hereditary disposition, a peculiar constitutional 
habit of the body, and may be excited by conditions incidental to 
modern social life, or atmospheric and telluric influences, or by 
emotional disturbances, such as terror, anxiety, disappointed 
love, homesickness and the like. 

Its Symtoms are manifold : 

1. Color of the skin. A conspicuous paleness, sometimes clear, 
sometimes yellowish, greenish, waxy. Even the lips and other 
mucous membranes appear pale; dark rings around the eyes. In 
some cases there is oedema of the feet, face and eyelids; tempera- 
ture decreased; breath cool; lips, nose, ears, hands and feet cold. 
The patient is sensitive to cold, seeks a warm room. 

2. Circulation. The pulse is usually small and compressible, 
varying in frequency, easily excited by any trifling cause. The 
heart's impulse varies likewise in frequency and in intensity, 
amounting often to strong palpitations. Sometimes the palpita- 
tion of the heart becomes habitual and is one of the most promi- 
nent, and, at the same time, most annoying symptoms. Physical 
signs are those of anosmia: systolic murmurs over the apex of the 
heart, and humming sounds over the jugular veins. The latter 
are the most constant. 

3. Respiration is frequently dyspneeic, especially after any exer- 
tion ; the patients sigh and cough occasionally. 

4. Muscular system. Great weakness; easily tired and exhausted. 

5. Nervous system. Dizziness; headache; noise in the ears, es- 
pecially in the right ear; pains in different parts of the body, es- 
pecially in the stomach and back; even hysterical spasms; sad- 



CHLOROSIS. 931 

ness; want of energy; frightful dreams; nightmare; melancholy, 
and even mania, and inclination to self-destruction. 

6. Digestion. Want of appetite; digestion slow; sour and foul 
eructations; desire for sour things; morbid desire for chalk, 
paper, ashes, coals, even excrements. Often the most undigest- 
ible things — pork, beans, pastry, etc. — suit better than light 
soups, meat, etc. However, these digestive symptoms are, in 
some chlorotic persons, entirely wanting. 

7. Genital sphere. There is generally amenorrhoea or irregular 
menstruation with pain; thin, watery leucorrhcea in place of the 
menses, or in some cases menorrhagia. 

Chlorosis is often combined with hysteria and choreic parox- 
ysms; also Basedow's or Grave's disease stands in undoubted 
connection with it; and other neuroses, such as cardialgia, head- 
ache, toothache, backache, etc., are found as frequently in chlo- 
rosis as in anaemia. 

Its Duration is variable; under proper treatment it may yield 
in a comparatively short time; otherwise it may last for years. 
Marriage sometimes relieves at once. Complications, such as 
acute febrile disease, phthisis, endocarditis, gastric ulcer, etc., of 
course change its favorable prognosis. 

THERAPEUTIC HINTS.— Ant. crud., menses commence at an early 
period, are profuse and cease afterwards; great deal of headache; 
peevishness; loss of appetite; irregular stool; excessive laziness 
and weakness ; must lie dow r n for hours ; deep and unrefreshing 
sleep at night. 

Arsen., trembling; frequent fainting; excessive debility; per- 
nicious anaemia. 

BeUad., laziness and indisposition to work or stir, great general 
debility, with weariness and a desire to sleep in the afternoon ; 
shortness of breath; extreme paleness of the face changes instanta- 
neously to redness, with cold cheeks and hot forehead. 

Bryon., all the symptoms w T orse from the slightest motion. 

Calc. carb., scrofulous diathesis ; disposition to colds and diar- 
rhoea ; great weakness or curvature of the spine ; vertigo, espe- 
cially on going up stairs; disgust for meat; craving for sour and 
even indigestible things (chalk, coal, etc.) ; after eating, swelling 
of the stomach and palpitation of the heart ; menses sometimes 
too often and too profuse, or wanting; leucorrhcea; great short- 
ness of breath ; great weakness of the muscles ; walking wearies 



932 BLOOD. 

and makes the heart palpitate; sitting causes severe backache 
and headache; therefore constant inclination to lie down; hands 
and feet are cold ; the fingers sometimes appear dead. The mind 
is generally full of concern about imaginary things that might 
happen to her. 

Garb, veg., when complicated with itch and fiuor albus ; gums 
swollen, scorbutic and receding from the teeth ; the teeth are 
loose ; feels wretched all over ; can scarcely walk. 

China, in such cases as result from loss of vital fluids, menstrual 
or vicarious bleeding, suppurations, etc. ; or which set in after 
severe and protracted illness, such as intermittent fevers, typhus, 
cholera, etc.; showing in either case a tendency to dropsical 
effusions and cedematous swellings. Besides we observe sour 
belching, poor digestion, bloated abdomen. 

Cilia, on drinking wine she shudders as though it were vinegar ; 
spasmodic yawning; headache, pain in the chest and back, 
caused hy fixing the eyes steadily upon some object, as, for 
example, when sewing; all these pains are aggravated by exter- 
nal pressure ; spells of intermittent fever every afternoon at four 
o'clock, with thirst and coldness of the hands and feet; colic and 
vomiting of ingesta; afterwards heat and sweat, followed by 
deep sleep. 

Conhim, menses wanting; genitals very sensitive: constant dry 
heat all over, without thirst; stitching pain in the region of the 
liver, and heaviness in the limbs ; weeping mood ; restlessness ; 
great concern about any little thing that may happen ; anxious 
dreams. 

Cuprum, disposition to laryngeal and tracheal affections, to vom- 
iting and purging; sweating of feet; torpid cases, (v. Grauvogl.) 

Cyclam., suppressed menses ; or scanty, painful menstruation ; 
headache ; vertigo ; swollen eyelids ; pale face, lips and gums ; 
loss of appetite ; no thirst; constipation; palpitation of the heart ; 
constant chilliness; dread of fresh air; disinclination to move 
and to work; constant drowsiness; wants to be alone, and weep- 
ing does her good. Is very similar to Pulsat, differing, however, 
from it, by its dread and disinclination for fresh air. 

Ferrum, anaemia, characterized by great paleness of all the mu- 
cous membranes, especially that of the cavity of the mouth, by 
the bellows-sound of the heart and anaemic murmur of the arteries 
and veins ; by great paleness of the face, which, however, i^ very 
apt to suddenly become fiery red, with vertigo ; ringing in the 



CHLOROSIS. 933 

ears ; great palpitation of the heart and dyspnoea ; thus showing 
a disposition to congestion and fluxion of blood to these parts of 
the body. All the muscles are feeble and easily exhausted from 
slight exertion ; there is frequent vomiting of ingesta, especially 
after eating, and from motion ; cardialgia ; the menses are either 
suppressed or watery; we observe general emaciation; cedema- 
tous swelling of the body ; cool skin ; constant chilliness and 
evening fever, similating very closely hectic fever. — Florid cases, 
with disposition to phthisis, haemoptysis, menorrhcea, scrofulous 
inflammation of eyes, diarrhoea, ascarites, etc. (v. Grauvogl.) 

Graphit., scanty, pale, delaying menses, or they do not appear 
at all; cool vagina; aversion to coitus; oedema of the eyelids, 
external genital organs and abdominal parietes, leaving on press- 
ure the imprint of the finger ; face pale and yellowish. 

Ignat, sensitive, nervous, hysteric women, who are inclined to 
spasmodic and intermitting complaints, and where the trouble is 
induced by mental emotions, such as fright, grief, disappointed 
love, etc. 

Ipec, headache, as though the brain were mashed, with nausea 
and vomiting ; miliary eruptions on the forehead and cheeks by 
spells ; pale face and pale mucous membranes ; weak pulse ; cold 
hands; morose, enjoys nothing. 

Natr. mur., in chronic cases and cachectic individuals, with 
dead, dirty, withered skin ; frequent palpitation and fluttering of 
the heart ; suppressed menstruation ; leucorrhcea ; diminished 
sexual desire ; oppression and anxiety of the chest ; sadness. 

Nux vom., especially in those cases in which the functions of 
the stomach, intestines and liver are principally affected, and we 
may observe a train of symptoms like the following : irritable, 
angry disposition; great anxious concern about little things; 
headache, with bilious or sour vomiting, worse in the morning ; 
pale, earthy face ; feeling badly after eating bread or sour things ; 
sour taste in the mouth ; craving for chalk ; nausea and vomit- 
ing in the morning or after eating ; cardialgia, with wind in the 
stomach; better from drinking something hot; obstinate consti- 
pation ; running of the nose through the day, and stoppage of it 
at night ; sore feeling all over in bed in the morning ; dreads 
motion and fresh air; gets awake early in the morning, then 
dozes again and wakes up finally, feeling much worse than at 
any other time. 

Phosphor., in deep-seated, chronic cases, with tubercular diathe- 



934 BLOOD. 

sis; brought on by depressing mental influences, such as grief, 
worriment, disappointed love, or by exhausting bodily causes, 
such as night-watching, loss of blood, diarrhoea, night-sweats, 
onanism, etc. We observe, in such cases, puffiness around the 
eyes, dry, hacking cough, great weakness in the sexual organs, 
consequent upon previous irritation of these parts; leucorrhcea 
of a whitish, watery slime, especially profuse during the time of 
the menses, sometimes acrid and corroding; a total loss of energy 
in all the organic functions of the body. 

Plumbum, want of breath and great oppression of the chest from 
motion; palpitation of the heart; obstinate constipation ; oedema 
of the feet and anasarca; great muscular weakness. 

Pulsat, great weakness and sluggishness in the circulation, 
manifesting itself in constant chilliness, coldness and paleness of 
the skin and face, with hot flashes and transitory redness of 
cheeks; soft, irregular pulse and palpitation of the heart, oppres- 
sion of the chest and shortness of breath; disinclination to move 
and a sad and tearful disposition; the appetite is generally ab- 
sent, and there is no thirst; the whole digestion is disturbed, and 
consequently the assimilation of nutriments for the blood does 
not take place properly. We observe, therefore, signs of anaemia, 
such as dizzness, especially when rising, and amenorrhcea, or 
scanty, slimy menses, which appear too late; in general the pa- 
tient feels better in the open air. This distinguishes Pulsat. 
from Cyclam. It is frequently indicated after Calc. carb., Ignat., 
Sepia or Sulphur, and is followed well by Ferrum. Disposition 
to intermittents, melancholia, hysteria, heart and kidney diseases, 
discharge from ears. (v. Grauvogl.) 

Sabina, amenorrhcea; frontal headache, pressing down upon 
eyes, worse in morning on rising, better in fresh air; blue rings 
around eyes; nausea and qualmishness when in a crowd; burn- 
ing in pit of stomach, with twisting and gurgling in bowels; 
bearing down; drawing pain in extremities, worse at night; las- 
situde and sleepiness. (Watzke.) 

Sepia, bearing-down as if everything would issue out of the 
genitals; prolapsus uteri and vagina; brown-reddish color of the 
vagina ; diphtheritic ulcers in the vagina and on the labia : leu- 
corrhcea, yellowish and passing away in starts; swelling of the 
external genital organs, with itching, burning and soreness; 
stitching pains in the ovarian region; palpitation of the heart: 
intermitting pulsation ; occasionally a hard thump of the heart: 



SCURVY, SCORBUTUS. 935 

frequent sickness at the stomach, brought on even by the smell 
of cooking. Uneasiness in the presence of strangers; sudden 
flushes; starting at trifles; tongue coated, most at root, clearing 
off in patches, leaving red surface; no menstruation. 

Sulphur, heat of the head with cold feet; inclination to religious 
reveries ; inflammation of the eyelids ; frequent, unsuccessful de- 
sire for stool ; leucorrhcea ; oppression of the chest with palpita- 
tion of the heart; exhaustion even from talking; feels worse 
while standing; cutaneous eruptions; sleepy in the daytime, 
restless at night ; perspires easily ; feels faint before dinner. Is 
often necessary as a foundation for the better action of other 
remedies. 

Besides compare : Alet. far., Alum., Helon., Senecio aur. 

8. Scurvy, Scorbutus. 

This disease belongs to the general disorders of nutrition and 
is characterized by an intense general cachexia in connection 
with various local eruptions, and disorders of a hsemorrhagic 
and hsemorrhagico-inflammatory character, most constantly ob- 
served in the gums. 

The occurrence of scurvy so extraordinarily frequent in the 
middle ages, has become much less frequent in our times ; but it 
is still occasionally observed on the land in times of famine, in 
places undergoing siege, in poorly ventilated dwellings, and in 
cold and damp regions and seasons; on the sea during long 
voyages upon sailing vessels, and especially when a gloomy and 
anxious state of mind, and poor food enter this combination of 
circumstances. As regards food there is no doubt, that a defi- 
ciency of fresh meat and vegetables, especially potatoes and 
greens, induces the disease in many cases. And because these 
articles of diet contain a greater percentage of potash, than salt 
meat, dried beans and the like, some authors have unreservedly 
laid the cause of scurvy in a deficiency of potash in the food. 
This, however, is obviously wrong, since many outbreaks of 
scurvy are recorded where there was no lack of these articles. 
Henc^e, it can also be seen that a mere dietetic treatment will not 
always suffice for a cure. But there are still other conditions 
mentioned under which scurvy has been seen to develop, namely: 
convalescence from typhus and acute exanthemata, surgical dis- 
eases, especially in military hospitals, and the dwelling together 



936 BLOOD. 

of old people in beneficiary hospitals. Its onset is usually insidi- 
ous and its course lingering. We observe at first a general debil- 
ity, lassitude, sleepiness and depression of spirits ; a sad-looking, 
pale, cachectic face, with blue rings around the eyes ; loss of ap- 
petite, except perhaps in some cases a craving for fresh, green or 
sour things ; the stool is slow, the urine scanty and the skin dry. 
With all this there are aching pains, especially in the popliteal 
space, with circumscribed hardness and a slight bluish color. 
After a few days the gums become swollen, spongy and bluish ; 
they bleed at the slightest touch. There is a bad taste in the 
mouth and a fetid breath. The general debility increases ; ecchy- 
mosed spots appear on the skin ; first on the legs, later all over the 
body, from the size of a lentil to that of a half-dollar and larger, 
at first looking purple, in severe cases black, later changing into 
all the different hues which extra vasated blood undergoes ; fre- 
quent nosebleed. All these symptoms may reach a still higher 
degree ; the weakness may augment to prostration, so that even the 
slightest exertion or motion may cause fainting; the gums may 
issue a fetid, ichorous, bloody fluid; the ecchymosed spots may 
change into blisters, filled with ichorous fluid and forming ulcers. 

The pain in the extremities may grow still severer, and the 
joints and bones may swell; effusions of fibrin beneath the skin 
may harden the legs like boards. The hard stools may change 
into a thin, ichorous and bloody diarrhoea, with colicky pains. 
The spleen is usually enlarged. Epistaxis increases, and there 
are even bloody secretions from the conjunctiva, respiratory 
organs, stomach (by vomiting), and from the urinary organs, in 
the form of bloody urine. 

If to all these symptoms be added extravasation of bloody 
serum into the pleura, the pericardium, the lungs, the brain or 
its membranes, the patient generally dies, either suddenly or 
gradually, in consequence of increasing prostration and hectic- 
fever. Of course, all cases do not terminate thus. Its duration, 
however, is long, lasting months, and convalescence is very slow, 
if left to nature. 

THERAPEUTIC HTNTS.— Special cases which have been brqught 
on by a deficiency of certain articles of food should certainly be 
supplied with these articles, as a matter of course, where it can 
be done. In other cases which owe their origin to other causes, 
the mere feeding with greens and acids will certainly be of no 
avail. We shall have to look again for help to the law of similars. 



SCURVY, SCORBUTUS. 937 

Agave Americana, countenance pale and dejected; gums swollen 
and bleeding; left leg, from ankle to groin, covered with dark 
purple blotches; leg swollen, painful, and of stony hardness; 
pulse small and feeble; appetite poor; bowels constipated. 

Amm. carb., hectic fever, profuse haemorrhages from the intes- 
tines, nose and gums ; falling out of the teeth ; muscles soft and 
flabby; emaciation. 

Arsen., the gums bleed readily; fetid smell from the mouth; 
violent thirst, which obliges him to drink frequently, although 
but little at a time; offensive diarrhoea; excessive debility; 
stiffness and immobility of the knees and feet, with violent 
tearing pains, worse about midnight, better from external warm 
applications; great despondency and restlessness. 

Canthar., pains in the gums; coagulated blood in the mouth, 
early in the morning, in bed ; bloody urine. 

Carb. veg., swelling, receding, and bleeding of the gums ; nose- 
bleed ; readily bleeding ulcers ; general physical depression ; at- 
tacks of sudden weakness, like fainting; after too much salty 
food. 

China, inertia; excessive debility; haemorrhage from the mouth, 
nose, and intestines ; great desire for sour things ; diarrhoea. 

Hydrast, physical prostration; fainty, weak feeling; ulcers on 
the legs. 

Kali phosph., easily bleeding gums ; putrid decomposition; pros- 
tration. 

Mercur., spongy, bleeding gums, of a sickly appearance ; they 
look white along the upper border and recede from the teeth ; 
bluish color of the inner cheeks; fetid smell from the mouth. 
Sinking with an indescribable malaise of body and soul, oblig- 
ing him to lie down ; fetid ulcers on the legs, which speedily 
become putrid ; spongy, bluish, readily bleeding ulcers. 

Mur. ac, swelling of the gums; scorbutic gums. 

Natr. mur., scorbutic, putrid inflammation of the gums ; bloody 
saliva; difficulty of talking, as if the organs of speech were weak. 

Nitr. ac, swelling and bleeding of the gums ; the teeth are 
loose ; bloody saliva ; putrid smell from the mouth ; after abuse 
of mercury. 

Nux vom., putrid bleeding ; swelling of the gums ; putrid 
ulcers in the mouth ; cadaverous smell from the mouth ; bloody 
saliva; spitting of blackish, coagulated blood, and blowing 
blood from the nose; pain in the limbs; great weariness and 
languor. 



938 BLOOD. 

Phosphor., the gums bleed easily and stand off from the teeth; 
sore, excoriated spots on the skin ; ecchymosed spots. 

Staphis., the gums are painful to touch and bleed easily on 
being touched ; scorbutic ulcers. 

Sulphur, swelling of the gums, with throbbing pain in them; 
bleeding ; fetid smell from the mouth ; sleeplessness at night ; 
desire for brandy. 

Besides, compare Cistus can., Crotal., Hepar, Kreosot, Sepia, 
Sulph. ac, Terebinth. 

9. Purpura Hemorrhagica, Morbus Maculosus Werlhofii. 

This is a transitory hsemorrhagic diathesis of sporadic occurrence 
and a relatively brief duration, the etiology of which is entirely 
unknown ; its development appears spontaneous. 

In this apparent spontaneity of its occurrence, without regard 
to age, previous health, or inherited predisposition of the indi- 
vidual attacked, it differs from haemophilia, scurvy and symp- 
tomatic tendency to bleeding, which is frequently observed as a 
consecutive or accompanying symptom of certain severe and 
acute or chronic diseases, such as variola, typhus exanthematicus, 
phosphorus-poisoning, leukaemia, pernicious anaemia, protracted 
icterus, etc. 

It often begins suddenly, without prodromal warnings, with 
petechia upon the skin or epistaxis; at other times its outbreak 
is preceded, for several days, by languor, headache, loss of appetite 
and even moderate fever. In still other cases it commences with 
rheumatic pains in the lower extremities, especially the knees 
and ankles, when it has been called Purpura rheumatica or Peliosis 
rheumatica. (Schoenlein.) 

The hsemorrhagic exanthem may extend over the entire body, 
and the individual spots vary greatly in size, from that of a pin- 
head to that of a lentil, a pea or a bean. The larger ecchymoses 
are rare, and assume every possible shape. These maculae are 
often interspersed with more or less numerous vesicles, which 
are evidently produced by circumscribed haemorrhages into the 
rete Malpighi from capillary loops of the papillae of the skin. 
The color of the maculae, when fresh, is dark bluish-red : later it 
changes successively to greenish-blue, brown and yellow. Press- 
ure does not alter the appearance. It is exceedingly common 
for fresh crops to appear at varying intervals during the disease, 



H.EMOPHILIA, H.EMORRHOPHILIA. 939 

which brings about the various colors of the different ages of 
these macula?. 

As long as the disease manifests itself as a mere cutaneous 
eruption, it is called Purpura simplex; when, however, it is at- 
tended by haemorrhages in other parts, it is called Purpura hemor- 
rhagica. Such haemorrhages may take place from the mucous 
membrane of the nose, mouth, stomach, intestines, urinary pas- 
sages, genitals in women, and bronchi; they are much more 
common in morbus maculosus than even in severe cases of 
scurvy ; but the bluish-red discoloration, the softening, swelling 
and spongy character of the gums, and the excessive sensitive- 
ness of these parts, which is characteristic of scurvy, are entirely 
wanting. Haemorrhages occur exceptionally also within the se- 
rous cavities, in the meninges and in the substance of the brain. 
Simple cases pass over in a week or two ; repeated and profuse 
haemorrhages may induce anaemic pallor, dropsical swellings, 
extreme weakness, fainting fits, etc. 

THERAPEUTIC HINTS.— Compare, as the most important reme- 
dies, dotal., Phosphor., Ledum, Bryon., Hamam., Secale, Arnica, Arsen., 
Ferr. phosph., Laches., Sulph. ac; and in cases of Epistaxis, Hae- 
matemesis, or Haematuria, the corresponding chapters. 

10. Haemophilia, Haemorrhophilia. 

By this name is meant a congenital haemorrhagic diathesis, 
in consequence of which even the slightest wounds, no matter 
where, always bleed very profusely. The cause is unexplain- 
able; we only know that this tendency to bleed exists in certain 
families, and is propagated to three or four generations ; some- 
times leaping over one link and appearing again in the follow- 
ing. The female members of such families are generally, al- 
though not always, exempt, but they are very apt to propagate 
this tendency to their male children. 

There are no objective signs by which this diathesis could be 
recognized before the bleeding sets in. Such persons, however, 
are described as having blonde or reddish hair, a very fair skin, 
with the blood-vessels shining through, and blue eyes. In some 
cases it shows itself immediately after birth, as an uncontrollable 
bleeding of the navel ; oftener during the first or second denti- 
tion, and in other cases still later. Then the blood oozes unin- 



940 BLOOD. 

terruptedly from the slightest wound, as out of a sponge, until 
the patient becomes exhausted from loss of blood. Mere bruises 
cause large effusions of blood into the cutaneous and subcutane- 
ous tissues. Spontaneous bleedings from the nose, which are by- 
far the most frequent, or from the lungs, stomach, intestines, or 
kidneys, do not take place until after several bleedings from ex- 
ternal wounds. Such spontaneous internal haemorrhages are 
mostly preceded by palpitation of the heart, oppression, conges- 
tion to the head, pain in the limbs, and, in some cases, by pain- 
ful swellings of the knee and ankle-joints. Bleeders seldom 
reach an old age ; in some cases, however, this tendency to bleed 
gradually diminishes with the advancing years, and ceases en- 
tirely at last. 

THERAPEUTIC HINTS.— It seems that Phosphor, must be the 
main remedy. Compare likewise Secale, and for internal bleed- 
ings those chapters which treat of the corresponding haemor- 
rhages. Eriger. is said to be very efficacious ; also : Natr. sulph, 
Crocus, China, Arsen., Hamam. 

11. Scrofulosis. 

We understand by this term a cachexia which manifests itself 
as a nutritive disturbance in the external skin, the mucous mem- 
branes, joints, bones, organs of sense, and, above all, in the lym- 
phatic glands, in such a manner that individuals thus affected 
betray the internal disorder by a peculiar habitus. According as 
the faulty nutrition leads either to an accumulation of fatty de- 
posits in certain parts of the body, or to a deficiency in fat on 
account of too rapid growth, scrofulosis has been divided into a 
torpid and an erethic form. The habitus of the first Canstatt por- 
traits in the following manner: "uncommonly large head; coarse 
features; thick, swollen nose and upper lip; broad cheek-bones; 
large belly; swollen glands on the neck; soft, flabby muscles." 
The erethic form he characterizes as follows: "conspicuous white 
skin, which reddens easily, and through which the blood-vessels 
shine forth; red lips and cheeks; bluish color of the sclerotica, 
which gives to the eyes an expression of languor : the muscles of 
such individuals are thin and flabby: the weight of the body 
does not correspond with their size, showing a want of solidity of 
the bones; their teeth are fair, bluish, glistening, long and nar- 






SCROFULOSIS. 941 

row, and their hair is soft." The majority of cases, however, lies 
between these two extremes, or represent a mixture of the char- 
acters of both, as it happens with all such classifications. 

The special changes in the skin are eruptions, which usually 
have their seat in the face and on the scalp, and they consist of 
a superficial dermatitis, with exudation of lymph upon the free 
surface, constituting eczema or impetigo, or, as they are likewise 
called, tinea or porrigo, etc. Destructive processes, like forms of 
lupus, do not take place until sometimes at a much later period. 

The scrofulous affections of the mucous membranes involve most 
generally by their secretion the adjacent parts of the external 
skin; thus we find that a scrofulous conjunctivitis, otitis or coryza 
is generally attended by an eczema either on the cheeks or about 
the entrance to the ear or on the upper lip. Bronchial and in- 
testinal catarrhs, or catarrhal affections of the urinary or sexual 
organs of scrofulous individuals are generally of an obstinate 
character. 

The scrofulous affections of the joints manifest themselves 
either as dropsical effusions, or as the so-called white swellings, 
or even as suppurating processes, constituting caries of the bone- 
ends and destruction of the capsular ligaments, as found in 
coxitis, gonarthrocace, etc. 

The bones themselves are attacked by inflammation of their 
texture or lining, constituting either osteitis or periostitis, or 
caries or necrosis, or all combined. 

Scrofulous affections of the organs of sense manifest themselves 
in the eyes, either as inflammation of the Meibomian glands, or 
as conjunctivitis or corneitis, which latter not unfrequently 
leaves behind spots and cicatrices upon that organ ; in the nose, 
as obstinate coryza, or, although only in quite rare cases, as 
lupus ; in the ears, as otitis, which may terminate even in de- 
struction of the petrous portion of the temporal bone. 

The greatest nutritive disturbances are sustained by the lym- 
phatic glands of scrofulous individuals. Everywhere, where there 
is an inflammatory process of the skin or in the mucous mem- 
branes, we find the adjacent lymphatic vessels and glands par- 
ticipate in that process. The glands swell and inflame, and the 
inflammation spreads from the parenchyma of the glands to the 
surrounding cellular tissue, causing suppuration and abscesses, 
which are of slow growth and great obstinacy, leaving on heal- 
ing almost always ugly cicatrices. "We find these glandular ab- 
scesses most frequently in the cervical region. But the lym- 



942 BLOOD. 

phatic glands of scrofulous individuals swell also without any 
inflammation of neighboring organs. 

This is almost a pathognomonic sign of scrofulosis. We some- 
times find whole convolutes of these glands enormously enlarged. 
The microscope shows no foreign elements in them ; their enlarge- 
ment consists therefore in a pure hypertrophy of their own cells. 
When they inflame and suppurate, they form, as above stated, ab- 
scesses, which break; in other cases, the puriform matter becomes 
desiccated into a cheesy mass,, and may be finally transformed into 
a chalky substance, when it appears under the skin as a hard, un- 
even protruberance. Such chalky masses not unfrequently irri- 
tate the adjacent parts, and give rise to troublesome inflamma- 
tion and suppuration of the glands. The main seat of these 
glandular swellings is the cervical region, especially behind the 
ears and under the lower jaws, extending sometimes as far down 
as the shoulders. But the bronchial and mesenteric glands also 
are not unfrequently the seat of this nutritive derangement, 

Scrofulosis is inherited as well as acquired. Inherited from 
scrofulous parents; also from parents suffering with tuberculo- 
sis, carcinoma or tertiary syphilis; or from parents of advanced 
age ; or, finally, from parents who are too near relatives. Still, 
it must be observed, that quite a number of children of parents, 
as desciibed above, are found entirely free of any scrofulous taint, 
whilst on the other hand congenital scrofulosis is met with in 
children whose parents belong to none of the above specified de- 
scriptions. Acquired it may be by poor or faulty diet, or by the 
want of exercise and fresh air; frequently by the joint action of 
different unhealthy influences. 

Its course is always chronic; sometimes periodically improv- 
ing, and then growing worse again. Its worst feature is its ten- 
dency to make children prone to the worst forms of illness of 
childhood, such as croup, hydrocephalus and tuberculosis, with 
which they combine and which they aggravate. Statistic show 
that most of the victims of these diseases are scrofulous children. 

THERAPEUTIC HINTS.— Compare in general, as the most im- 
portant remedies, Aln. rub., Asaf., Aurum, Badiaga, Baryt. carb., 
Bellad., Calc. carb., Calc. phosph., Cistus, Conium, Hepar. Iodium, 
Lycop., Mercur., Natr. mur., Rhus tox., Sepia, Silic, Sulphur. 

For special hints, reference is made to the special ailments un- 
der their respective heads, and to Goullon's Scrofulous Affections, 
translated by E. Tietze, M.D. 



FEVER. 



Fever is characterized by these two points: an increase of tem- 
perature of the body and a rapid consumption of bodily sub- 
stance. 

Without an increase in the natural heat of the body, there is no 
fever. It is necessary, therefore, to know something about — 

Clinical Thermometry. 

The normal temperature in the axilla of a healthy person ranges 
between 97.25° and 99.5° F.; the mean is 98.6° F. This temper- 
ature is nearly the same in all climates, and keeps its standard 
alike in summer and winter. Its daily oscillations are most 
marked after meal-times, when there is a slight rise. The mean 
temperature we find a short time before the main meal, its 
maximum about four hours after the main meal, and its mini- 
mum in the night hours. 

In order to ascertain the degree of temperature of a person, it 
is sufficient that the bulb of the instrument be held for five or 
ten minutes firmly in the hand, or, what is much more prefer- 
able with patients, to insert the bulb into the axilla, taking care 
that it be entirely surrounded by the adjacent parts. This is 
easily secured by slightly pressing the upper arm against the 
chest. In this way the instrument is kept in a firm position, 
and after the lapse of five or ten minutes the quicksilver par- 
takes of the same degree of warmth as the surrounding parts, 
and its expansion can easily be read on the scale of the in- 
strument. ' 

" A normal temperature does not necessarily indicate health ; 
but all those whose temperature either exceeds or falls short of 
the normal range, are unhealthy." 



944 i FEVER. 

"The range of temperature in severe diseases is between 95° F. 
and 108.5° F., and very seldom falls below 91.4° F., or rises to 
109.4° F., though in rare cases it has reached 112.55° F." "Al- 
terations of temperature may be confined to special regions, 
whilst the rest of the body remains almost normal; they seldom 
exceed 1.8° to 2° F." "A rapid increase in the heat of the body, 
and decrease of the heat of the extremities, is associated with 
' cold shivers, rigors, fever-frost.' " 

"A protracted temperature of 101.3° F. or more, is usually 
accompanied with heat, lassitude, thirst, headache, frequency of 
pulse; if persisting, with diminution of body-weight, 'pyrexia,' 
fever, fever-heat." "Any considerable diminution of warmth in 
the extremities, with very high, or very low central temperature, 
is expressed by a small pulse, sunken features, weakness, nausea, 
cold sweating, collapse." 

" Temperatures much below 96.8 F. are ' collapse ' temperatures. 
Below 92.13° F. deep, fatal algide collapse. 

92.3 to 95° algide collapse with great danger, still with possi- 
bility of recovery. 

95 to 96.8° F., moderate collapse, in itself without danger. 

99.5° to 100.4°, sub-febrile temperature. 

100.4° to 101.12°, slight febrile action. 

101.3° to 102.2° in morning, rising to 103.1° in evening, mod- 
erate fever. 

103.1° in morning and about 104° in evening, considerable 
fever. 

103.1° in morning and above 104.9° in evening, high fever. 

107.6° and above indicates a fatal termination, except in re- 
lapsing fever ; hyperpyretic temperatures." 

"There is often a contrast between the temperature and the 
frequency of the pulse; though as a rule, slight febrile heat coin- 
cides with a pulse of 80 to 90 ; moderate fever with 90 to 10S ; con- 
siderable fever with 108 to 120; extreme heat with 120 and up- 
ward per minute." 

"A pulse rather slow in proportion to the temperature is favor- 
able as indicating a tranquil nervous system. A low pulse with 
high temperature invites us to look for spinal cause, as pressure 
on the brain, depressing action of drugs, etc." 

"A low temperature and frequent pulse points to local compli- 
cations in the thorax or pelvis. Not forgetting, however, that 
moving accelerates the pulse." 






CRISIS AND CRITICAL DAYS. 945 

" The number of respirations per minute does not correspond so 
closely to the temperature as the frequency of the pulse. In col- 
lapse there is often (not always) a frequency of respiration, and 
in slight fever of childhood also; in moderate fever the respira- 
tions amount to 20 or so per minute; in children to 40 or 50. 
In considerable or extreme degrees of fever they are higher yet, 
60 in many cases ; movement also increases their frequency. In 
other cases a quickened respiration indicates local causes." (Med- 
ical Thermometry and Human Temperature by Wunderlich 
and Seguin.) 

The temperature in special diseases is stated in the correspond- 
ing chapters. 

Crisis and Critical Days. 

Already Hippocrates, in the twenty-fourth aphorism of the 
second book, teaches in regard to critical days as follows : " Of 
seven days, it is the fourth that is indicative. With the eighth 
day begins the second week. The eleventh again must be ob- 
served, because it is the fourth day of the second week. So also 
must be noticed the seventeenth day, as it is the fourth from the 
fourteenth and the seventh day from the eleventh." And in 
aphorism thirty-six, in the fourth book, he says: "Such sweats, 
which occur in fever-patients on the 3d, 5th, 7th, 9th, 11th, 14th, 
17th, 21st, 27th, 31st or 34th day, are salutary, because they 
bring on a favorable turn in the disease. If sweats, however, 
occur on other days, they denote exhaustion, obstinacy, and re- 
lapse of the disease." 

These remarks are no doubt the result of a large amount of 
observation on fever-patients which, having been left to nature, 
afforded a clear basis for observation. As such, they have been 
verified up to this day. As the most important of tbese critical 
days are acknowledged the 3d, 5th, 7th, 13th and 21st. Why is 
it that these clays should have more importance in the course of 
a disease than others? Is there any natural connection between 
these odd numbers and the diseased states of the body? The old 
school has acknowledged the Hippocratic facts, but has never 
succeeded in solving the perplexed question. Just as many 
other things, which belong to the interior vital workings, could 
not be solved until the higher light of Homoeopathy had been 
made to shine upon the organism, so also had this problem to 



046 FEVER. 

wait until Dr. v. Grauvogl caught the seemingly loose and uncon- 
nected threads between odd days and certain developments in 
disease, and showed their legitimate connection by nature's own 
laws. I shall now try to condense his views on this subject as 
he has set them forth elaborately in his "Lehrbuch der Homceo- 
pathie." 

According to physiological experiments it appears that a liv- 
ing organismus, when it is subjected to a starving process, does 
not lose its bodily substance evenly, but rather periodically, so 
that its greatest losses always fall upon the fifth, eighth and 
thirteenth day. Thus the operations in a living organism differ 
essentially from mere mechanical or chemical operation. If you, 
for example, expose a vessel with water to an equally dry atmos- 
phere, it will lose its contents by evaporation evenly, just so 
much an hour. The living organism does not. It regulates its 
expenditures, or its losses, according to its own laws, which allow 
its receipts and expenditures to oscillate between a certain 
boundary, and make its operations to go on in regular periods. 
These periodical fluctuations are, therefore, the law of normal life, 
part and portion of all its evolutions in health and disease, and 
are not peculiar to states of disease. When, therefore, in diseases 
on the third, fifth, seventh, thirteenth, twenty-first and thirty- 
fifth day, a greater amount of losses sets in in the form of excre- 
tions, such as sweat, flow of urine, diarrhoea, etc., which is called 
the crisis, it is nothing more nor less than the same periodic os- 
cillation which is going on continually in the living organism, 
and which becomes more conspicuous only in disease, because it 
is frequently followed by a decided improvement or death. 

It necessarily must become more conspicuous, because this pe- 
riodical loss is added to the extra consumption, which is a con- 
dition of the acute disease. If the physical state of the patient 
be such as to endure both, he, of course, must feel better the 
next day, when the periodical acme ceases ; and he dies, if his 
physical power cannot endure the united action of both. 

Thus the critical days of the disease are nothing more nor less 
than the normal, periodical fluctuations of the living organism, 
with which they correspond; and the crisis is that critical day 
with its normally increased excretions, which falls together with 
the height of the disease. These observations are corroborated 
by the following facts: that the so-called crisis does not appear 
when, during the course of a disease, the organism is weakened 






INTERMITTENT FEVER, FEVER AND AGUE. 947 

by improper medication, because then the natural periodic fluctua- 
tion is disturbed and destroyed; and it does not appear when, by 
the application of the proper remedy, health is restored ; because 
the periodic fluctuation alone is not conspicuous enough to be 
observed. 

It is, however, never wanting when the disease runs an undis- 
turbed course ; and, in so far, it is an important means to dis- 
tinguish between a successful and an unsuccessful treatment. 
This is the theory of Grauvogl. 

It may be proper to add some further conclusions as to the 
importance of watching the critical days during homoeopathic 
treatment. 

1. The right remedy cures a disease without a crisis; and thus 
we have an indisputable proof that the selected remedy was the 
remedy. 

2. Aggravations after a remedy, when they occur on critical 
days, need not be the result of the remedy, as the conjoined ac- 
tion of the disease and the periodical oscillation alone will cause 
them naturally. 

3. When, after the administration of a homoeopathic remedy, 
a crisis takes place notwithstanding, we may be sure that we did 
not " hit " the case, and that the patient got well without our aid. 

4. AVhen no crisis appears, and the patient gets worse and 
worse, it is clear that we did not find the right remedy, and we 
may even have spoiled the case by wrong means. 

Lastly, it seems to explain the observation that in most chronic 
cases the well selected remedy develops its action visibly not be- 
fore the eighth day, and that we then ought not to disturb its 
action either by repetition or change, before the thirty-fifth day. 

Intermittent Fever, Fever and Ague. 

This fever is caused by a poison which, under certain condi- 
tions, originates in marshy lands, swamps, in low regions near 
rivers, in newly settled places which just came under the hand 
of cultivation ; in the neighborhood of canals when first dug ; in 
regions which seemingly lie dry, but contain a great deal of un- 
der-ground water ; the dryer the surface the greater the effluvia 
from underneath the porous and cracked crust. This poison is 
called swamp-miasma, or malaria. Its nature is entirely unknown, 
but differs totally from typhus, small-pox, scarlatina and measles 



948 FEVER. 

virus, as it never is propagated or carried from one person or 
place to another. Although swamps, damp, low regions, etc., are 
necessary for its development, yet they seem not the only condi- 
tions under which malaria is generated. Neither does the heat 
of the sun, the decay of vegetable substances, explain fully its 
presence here and its absence there ; because there are large 
tracts of land where all these conditions exist without any sign 
of miasma; whilst, on the other hand, we find small, confined 
districts in which ague prevails every spring and summer. 
Another peculiarity of the poison is, that it seems to spread hori- 
zontally, so that it is often prevented from spreading further by 
a wall, a hedge, unless carried over these obstacles by a blast of 
wind. In those places where the miasma develops itself, ague 
prevails endemic; but how widely spread epidemics of intermit- 
tent fever originate is wholly unexplainable. So, also, have 
great ague epidemics been the forerunner of the Asiatic cholera : 
in hot climates both are often found together, and still more fre- 
quently go hand-in-hand, typhus fever, dysentery, influenza and 
ague ; all which facts we cannot explain. Quite inexplicable is 
also the occurrence of sporadic cases in places where the miasma 
never prevails, and the attacked person had never been in a ma- 
larial region. 

Besides this malarial theory of origin we have a neurotic, a 
cryptogamic and also a splenic theory as to the cause of intermit- 
tent fever. 

The liability to invasion by the miasma is a very general one : 
no age or sex being exempted. Unlike small-pox, scarlatina, etc., 
the liability to repeated attacks increases after the first invasion. 
Persons thoroughly saturated with the poison may not suffer 
any more with acute outbreaks of chills and fever, but are more 
subject to a chronic enlargement of the spleen and a malaria 
cachexia. 

The time of incubation is not known with certainty; in some 
cases the poison seems to develop its consequences at once, and 
in others it seems to linger in the system from six to twenty 
days, in still others three, six, and ever nine months. Before, 
however, it produces its own characteristic type of paroxysms of 
chills and fever, with intervals of immunity — apyrexia — it often 
manifests itself for a while only as a general indisposition — a gen- 
eral malaise and disturbance of different functions. 

The real paroxysm of an intermittent fever consists of three 
stages — the chill, the heat, and the siveat. 



INTERMITTENT FEVER, FEVER AND AGUE. 949 

The chilly stage may last from a few minutes to full three hours. 
During this stage the appearance of the patient is remarkably 
altered; his whole volume seems to shrink; his face appears 
sunken, his nose pinched, and the rings on his fingers (if he 
wears any) become quite loose. The arterial blood is prevented 
from reaching the surface, while the venous blood is stagnated in 
the capillaries; this makes the skin pale and the lips and nails 
blue. The whole surface is cold, and covered with the well- 
known appearance of goose-skin (cutis anserina). The internal 
temperature, however, increases rapidly from two to three, even 
to five and seven degrees above the normal standard. The at- 
tending symptoms of this stage are numerous and various — 
headache, thirst, colic, cough, oppression, backache, etc., etc. ; 
either one, or all, or still others, may exist in a lighter or 
graver degree or- not at all at that stage. 

The stage of heat creeps on slowly, still intermingled with chilly 
sensations. Finally, the whole body is in a perfect blaze; the 
temperature rises still higher and remains so until near the end 
of this stage. There have been cases observed where the thermo- 
meter rose to 108.5° and 109.4° F. Physical examinations may 
also detect a swelling of the spleen, which, having commenced 
during the chill, reaches its height during this stage. The heat 
generally lasts from a few to eight, or even twelve hours. Here, 
too, as in the chilly stage, the attending symptoms vary in num- 
ber and character in each individual case. 

The third stage, that of sweat, finally closes the paroxysm, and, 
in most cases, greatly relieves the sufferings of the patient. The 
temperature sinks step by step till at last the patient feels more 
or less completely well again. There are, however, enough cases 
in which this last stage is likewise attended by a number of 
various symptoms, which, indeed, are important, like those of 
the first and second stage, in regard to the selection of the 
remedy, but have no particular bearing on the diagnosis of 
the case. 

The apyrexia which now follows is very seldom entirely free of 
all morbid manifestations, and these are likewise numerous and 
various, and for the observant homoeopathic physician of the 
highest importance. Just these manifestations may present to 
him the hints which will lead him to the discovery of the re- 
quired remedy for the case. 

When an intermittent fever develops its paroxysms in these 



950 FEVER. 

three stages, and in this order, it is called intermittens complete; 
when, however, one or the other of the stages is wanting, it is 
called intermittens incomplete; and when the order of its stages is 
reversed, so that, for example, the paroxysm commences with 
sweat and ends with the chill, it is called intermittens inversa. 

The apyrexia is, in different cases, of variable duration. It 
may last only six, eight or twelve hours, so that the new par- 
oxysm sets in after twenty-four hours from the one preceding, 
then it is called a daily or quotidian fever; if twice twenty-four 
hours elapse between the paroxysms, it is called a tertian fever ; 
and if three times twenty-four hours intervene, it is called a 
quartan fever. Sometimes it recurs only every seventh day — 
intermittens septiana. 

The most frequent forms are the quotidian and tertian. Some- 
times it happens that the paroxysms keep no regular times ; they 
either set in each time earlier (anticipating), or later (postponing). 
In such cases it may come to pass that the original type is alto- 
gether changed into another; for example, a quotidian by post- 
poning into a tertian, or a tertian by anteponing into a quotidian. 
When a fever-paroxysm lasts so long that its end reaches to the 
beginning of a new paroxysm, it is called &_febris intermittens 
subintrans. AVhen, however, the intervals of a quotidian, tertian, 
or quartan fever are again interrupted by another paroxysm, 
then it is called a febris intermittens duplicate. The double quo- 
tidian consists of two paroxysms within twenty-four hours, the 
intervening being generally lighter than the original. The 
double tertian has one paroxysm every day, mostly at different 
hours, and again the intervening lighter than the original; while 
the double quartan has two paroxysms in three days, and in 
this way, that two successive days are fever days, and the third 
day is free. 

Mashed intcrmittents show themselves usually as typical neural- 
gias, in the course of one or another nerve trunk, which, however, 
cannot be distinguished from other neuralgias, except by their 
typical recurrence ; they manifest themselves also in the form of 
intermittent hypersemia, haemorrhage, oedema, coryza, bronchial 
catarrh, etc., as typical skin affections, such as erysipelas, purpura, 
urticaria, pemphigus, and in many other typical forms of diseases. 

A long-continued, often-times suppressed intermittent fever fre- 
quently terminates in dropsy in consequence of existing func- 
tional disturbances of the spleen, which gradually become an 






INTERMITTENT FEVER, FEVER AND AGUE. 951 

organic lesion, or in chronic parenchymatous nephritis, or scor- 
butic affections and general ague cachexia. 

THERAPEUTIC HINTS.— Aeon., in recent cases of young individ- 
uals of a full habit; all the stages must be sharply marked, with 
a prominent congested state of the head and chest. The pulse is 
full, hard and frequent. During the chill internal heat, with 
great anxiety, sensitiveness and restlessness ; the pupils are con- 
tracted. The heat is confined mostly to the head and face ; great 
thirst for cold water and inclination to uncover. The sweat is 
most prominent on the parts covered, and is attended with ear- 
ache and profuse micturition. 

Ant. crud., predominant gastric symptoms : thick-coated tongue ; 
bitter taste; nausea; belching; vomiting; loss of appetite ; little 
or no thirst; pain in the bowels, diarrhoea or constipation. Sweat 
breaks out after the chill with the heat but soon disappears, dry 
heat continuing. 

Apis, according to Wolf, is one of the most important reme- 
dies in all kinds of intermittent fevers, and indeed has been 
used everywhere with great success. Chill with thirst about 
three or four o'clock p.m.; worse in a warm room or near the 
stove; renewed chilliness from slightest motion, with heat of the 
face and hands. Heat, especially in the chest, pit of the stomach, 
bowels, female organs, and hands, with muttering and uncon- 
sciousness ; diarrhoea ; shortness of breath ; drowsiness or sleep- 
lessness ; rarely thirst. Sweat alternates with dryness of the skin ; 
no thirst. Nettle-rash during sweat or apyrexia. During the 
apyrexia, pain under the short ribs, worse on the left side ; great 
soreness of all the limbs and joints ; great debility ; enlargement 
of the abdomen ; swollen feet and scanty urine. Apis is therefore 
indicated not only in recent but also in protracted and badly- 
treated cases. After it Natr. mur. follows well. 

Arnica, before and during the chill great thirst ; drinks a great 
deal, and vomits afterwards ; yawning and stretching ; pain in 
all the bones ; bed and sofa feel too hard ; the chill is felt worst 
in the pit of the stomach ; cold hands and feet, with heat in the 
head and face, and redness of one cheek ; heat, with indifference, 
stupor; drinks less; the sweat smells sour; during the apyrexia 
stitching pain in the region of the spleen ; soreness of the spleen 
on pressure ; aching in all the limbs as though beaten. 

Arsen., intermittens incompleta. Before the attack : vertigo ; 



952 FEVER. 

headache ; yawning ; stretching ; general discomfort ; weakness ; 
pain in the pit of the stomach and empty eructations ; cutting 
pain in the bowels. The chill is frequently intermixed with heat ; 
or heat and chilliness follow each other in rapid succession ; or 
the patient feels cold inside and burning hot outside. During 
the chill : generally no thirst; if there be any, drinking increases 
the chill and causes vomiting; oppression and spasms in the 
chest, with hacking cough ; bloating of the pit of the stomach ; 
pain in the pit of the stomach ; anxiety, restlessness ; blue nails. 
The heat is either wanting, or mixed up with the chill, or is very 
great, with delirium, unconsciousness and headache; restlessness; 
anxiety; pulsation through the whole body ; tension and pressure 
in the left hypochondrium ; burning in the stomach : generally 
great thirst, but drinking little at a time ; oppression and short 
breathing ; palpitation of the heart. The sweat sets in some time 
after the heat, or does not appear at all ; during the sweat the 
thirst is often the greatest, and the patient drinks large quantities 
of water; the symptoms of the former stages become ameliorated. 
The apyrexia is never clear. The face is pale, sunken, earthy, 
sallow, bloated ; the lips are pale, cracked, swollen and crusty ; 
the tongue is white and dry, or coated yellowish ; the taste is 
gone, without bad taste, only after eating, bitter taste ; the appetite 
is sometimes increased for a while, satisfying it causes heat and 
nausea, and not satisfying it causes an unpleasant sensation of 
discomfort; the hypochondriac regions are swollen, especially 
the left, the abdomen is bloated ; the stools are diarrhceic, fetid ; 
the urine is rather scanty and turbid, the feet are cedematous ; 
the skin is pale, often covered with cold perspiration ; there is 
sleeplessness, especially the night before a new paroxysm, and 
great sinking of general strength. 

Bellad., the heat predominates, with vertigo, hallucinations, de- 
lirium, restlessness, anxiety; drowsiness with inability to go to 
sleep, or sopor; headache, throbbing in right temple, injected 
eyes, and sensitiveness to light; red cheeks; throbbing of the 
carotid arteries; choking sensation in the throat; great thirst 
and dryness of the mouth and throat; palpitation of the heart; 
painful swelling of the spleen; constipation; great irritability of 
temper, or else tearful mood. 

Bryon., the chill predominates, only exceptionally the heat; 
great thirst during the chill, still greater during the heat: the 
sweat lasts long. There is, as the most important leading symp- 



INTERMITTENT FEVER, FEVER AND AGUE. 953 

toms: stitching pain in the sides of the chest, with hard cough; 
stitching pains in the hypochondriac regions and in the abdo- 
men; rheumatic pains in the limbs; all worse from motion. 

Cact. grand., regular paroxysms at 11 o'clock a.m. or p.m.; first 
chill, then burning heat, with headache, coma, stupefaction, in- 
sensibility; thirst, shortness of breath, inability to remain lying. 
The sweat is profuse, and attended with inextinguishable thirst. 
The apyrexia is complete. 

Calc. carb., chronic cases; chill commences in pit of stomach; 
thirst during the chill. General indications: hardness of hear- 
ing; pot-belliedness; hard, bloated stomach; enlarged spleen; 
diarrhoea white, undigested; monthly period too early and too 
profuse; glandular swellings about the neck; altogether scrofu- 
lous diathesis. 

Gapsic, chill, mostly with thirst, and worse after drinking; the 
chill commences in the back and spreads all over, and is relieved 
by hot irons or jugs of hot water; after the chill sweat; or heat, 
with sweat and thirst at the same time. During the chill: gid- 
diness and excruciating tearing pains in the back and limbs, 
extorting cries and causing the patient to bend together like a 
hedgehog. During the heat: cutting pain in the bowels, and 
slimy, burning stools, with much pressing and bearing down ; 
headache. 

Carb. veg., irregular paroxysms, sometimes commencing with 
sweat, followed by chill. Before the attack toothache, headache 
and pain in the limbs. During the chill great thirst. Heat and 
sweat frequently mixed together, with evening hoarseness, dizzi- 
ness, red face, nausea, but no thirst. The sweat is sour and some- 
times very profuse. Afterwards long-continued headache; heat 
and burning in the eyes; yellow complexion; liver-spots in the 
face; belching; bad smell from the mouth; stomach bloated; 
spleen swollen and painful; abuse of quinine. 

Cedron, chill at 3 a.m. or 3 p.m., is preceded by mental depres- 
sion, or excitement; during chill no thirst; chill predominates; 
during heat thirst for warm drinks ; numb, dead feeling in legs ; 
sweat profuse, with thirst and tearing pains in extremities. Dur- 
ing apyrexia general malaise and great debility. 

Chamom., heat and sweat predominate, and are often together ; red 
face, or only one cheek red and the other pale; sweat especially 
about the head, and mostly hot. The tongue is red in the mid- 
dle and white on the sides, or white in the middle and red on 



954 FEVER. 

the edges; bitter taste; bitter vomiting; great oppression about 
the heart; diarrhoea. The patient is very irritable, excited, com- 
plaining, with great restlessness and anxiety. 

China, the paroxysms come mostly at irregular hours, with 
thirst before (not during) chill or heat and during the sweat; 
they are mostly preceded by palpitation of the heart with anx- 
iety; sneezing; nausea; hunger; pressure in the stomach; pain 
in the bowels and jerking, tearing headache; pain in the limbs 
and great debility. During the fever the veins appear greatly 
enlarged, and there is great congestion to the head, with redness 
and heat of the face, even with chilliness and coldness of other 
parts of the body. The sweat is sometimes only partial and cold, 
for example, on the forehead; at other times it is profuse, and 
almost always attended with thirst. In general the patient 
sweats easily, especially at night, during sleep ; there is swelling 
of the liver and spleen, painful to motion and pressure ; a char- 
acteristic weakness, exhaustion and cachectic appearance, a sal- 
low yellowishness of the skin, not only in the face but also on 
the chest and region of the stomach, and different anaemic and 
dropsical symptoms. The urine is scanty and turbid, with a 
thick yellowish or brick-dust sediment, or a sediment of little 
crystals. The presence of swamp miasma is another indication. 

Chin, sulph., regular paroxysms at the same hour, and clear in- 
termissions; real thirst mostly only during the sweat. During 
the paroxysm pain in the dorsal vertebree on pressure; pain in the 
region of the liver and spleen on bending, taking a deep breath, 
coughing; the urine gives a voluminous, brick-dust-like or fatty 
sediment, or contains crystals of urates; ringing in the ears, with 
dizziness and enlarged feeling of the head. 

Cimex, before the chill thirst and heaviness in the legs. The 
chill commences with clenching of the hands and violent raging; 
it is attended with pains in all the joints ; sensation as if the 
tendons were too short ; the knee-joints are usually contracted, 
so that the legs cannot be stretched; the chest feels oppressed, 
obliging one to frequently take a long breath ; irresistible sleepi- 
ness; it ends with a tired feeling in the legs, obliging one to 
change position constantly; with thirst; drinking, however, 
causes violent headache ; continuous dry cough ; oppression of 
breathing ; heaviness in the middle of the chest : anxiety. Ab- 
staining from drinking ameliorates all this. The heat is at- 
tended with gagging; the oesophagus feels constricted, and the 



INTERMITTENT FEVER, FEVER AND AGUE. 955 

water drank goes down only at intervals ; no thirst. The sweat 
is mostly on the head and chest, accompanied by hunger. 

Cina, thirst only during the chill, or only during the heat. 
Nausea, vomiting, diarrhoea, pain in the stomach and abdomen 
may set in at any time, and soon be followed by a clean tongue 
and ravenous appetite. The face is puffed and pale even during 
the heat, or glowing red ; the pupils are much enlarged, and the 
child picks often at the nose. 

Diadema, paroxysms every day or every other day at precisely 
the same hour; chill predominating; constant chilly feeling; 
always worse on rainy, cold days ; menses too early and too pro- 
fuse ; enlargement of the spleen. 

Eupat. perf., long before the chill great thirst, which continues 
through chill and heat; after drinking, vomiting; the parox- 
ysms usually occur in the morning, about seven or nine o'clock ; 
they are attended with intense aching in the back and limbs, as 
if the bones were broken, and with a number of gastric or so-called 
bilious symptoms ; the sweat is generally not very prominent, or 
even wanting, but sometimes drenching, and the intermisson is 
sometimes marked by a loose cough. 

Eupat. purp., the paroxysm comes at different times in the day, 
every other day ; chill commences in the small of the back and then 
spreads over the body ; violent shaking, with comparatively little 
coldness; thirst during chill and heat; vomiting between chill 
and heat; violent bone-pains during chill and heat. 

Ferrum, similar to Arsen. and China, it will frequently be of 
service in protracted and badly-treated cases by quinine, which 
are characterized by ansemia and total prostration of the repro- 
ductive sphere of the system. We observe great paleness of the 
face, which, however, may flush up from any excitement to a 
fiery redness of short duration ; paleness, whiteness of the inner 
surface of the mouth ; vomiting of everything that is eaten with- 
out being digested ; swelling and hardness in the hypochondriac 
regions ; great weakness and emaciation ; dropsical swelling of 
the feet ; frequent congestion of the lungs ; continued shortness 
of breath ; nun's murmur in the veins. 

Gelsem., chill in afternoon or evening, commencing in hands 
and feet, or running up back from sacrum to occiput, without 
thirst ; or only fever at 10 a.m., without chill and without thirst. 
The heat is attended with red face and sleep, or with nervous 
restlessness, delirium, mental anxiety or agitation, vertigo; a 



956 FEVER. 

curious sensation of falling, sensitiveness to light and sound, par- 
tial blindness or deafness. Where there is a want of distinct- 
ness in its several stages, the whole presents an adynamic condi- 
tion of the system. 

. Hepar, bitter taste in the mouth ; bilious vomiting ; diarrhoea ; 
itching, stinging nettle-rash before and during the chill ; fever-blis- 
ters around the mouth ; tettery eruption on the chest ; previous 
abuse of mercury. During the sweat keeps himself closely 
covered. 

Ignat, thirst only during the chill, or in short spells, independ- 
ent of any stage. The chilliness is relieved by the external ap- 
plication of warm things ; external heat, or heat in some, and 
coldness of other parts of the body ; sometimes with pain in the 
bowels ; afterwards sleep and sweat, The paroxysms are some- 
times accompanied with spasmodic symptoms ; heaviness of the 
head; aching pain in the occiput; vomiting and pressive pain 
in the pit of the stomach ; urticaria over the whole body. The 
paroxysms are apt to postpone or antepone. 

Ipec, predominance of gastric symptoms during the paroxysm 
as well as during the apyrexia. It begins chiefly with yawning, 
stretching, and a collection of saliva in the mouth ; then follows 
the chill, aggravated by external warmth, with or without nau- 
sea, vomiting, diarrhoea, or great oppression of the chest, with 
heaving. The three stages may be very strongly marked or 
very light; the thirst is generally quite inconsiderable in all of 
them. The apyrexia has the same gastric symptoms, especiall}' 
a marked sensation of relaxation of the stomach, as though it 
were hanging down ; entire loss of appetite. The spleen is little, 
if any, swollen. Miasma; after the abuse of quinine and arseni- 
cum ; after faults in diet. 

Laches., one of the most important remedies after the abuse of 
quinine. The paroxysms are mostly in the afternoon, with pain 
in the small of the back and limbs; restlessness; oppression of 
the chest ; jerking ; headache ; red face ; talkativeness. During 
the chill wants to lie near the fire, or be held tightly to relieve 
the pain in head and chest, and prevent shaking. 

Lycop., where there are other chronic symptoms — cough, with 
thick, yellow, salty expectoration ; oppression of the chest ; pain 
in the left side ; palpitation of the heart ; pale face, often with 
circumscribed redness of the cheeks; sour vomiting between 
chill and fever; bloatedness of the stomach; rumbling in the 



INTERMITTENT FEVER, FEVER AND AGUE. 957 

bowels; great debility; the sweat is often sour and profuse, some- 
times following immediately upon the chill, and at other times 
not until some time after the heat ; after the sweat, thirst. Fever 
paroxysms often from 4 to 8 p.m. 

Mangan., incomplete intermittent, consisting of only heat and 
sweat, with moderate thirst. 

Menyanth., irregular time and type ; chill predominating with- 
out thirst; especially coldness of fingers, toes and legs, not re- 
lieved by external warmth, of abdomen. 

Mezer., incomplete intermittent, consisting of chill with thirst, 
and sweat with sleep. 

Natr. mur., one of the most important of all in recent as well as 
in inveterate and badly-treated cases. Hard chill very often at 
10 or 11 o'clock a.m., with great thirst which continues through 
all stages. The heat is characterized by the most violent head- 
ache, relieved by perspiration. There soon appears an eruption 
of hydroa or fever-blisters, which cover the upper and lower lip 
like pearls. During the apyrexia sallow complexion, dry, white- 
coated tongue ; bitter taste ; water tastes bad ; loss of appetite ; 
after eating, sour belching and vomiting ; pressure in the stom- 
ach ; swollen stomach ; pain in the region of the kidneys; cutting 
pain in the urethra after micturition. 

Nux vom. is characterized by great prostration and paralytic 
weakness from the beginning. Hard chill with bluish face and 
blue nails ; stitching pain in the abdomen ; spasmodic drawing 
and stiffness of the lower extremities; great thirst; the heat is 
great, and notwithstanding this the patient covers himself all 
over, because uncovering or the slightest motion makes him feel 
chilly ; headache ; great thirst, especially for beer. Both chill and 
heat are accompanied with gastric and bilious symptoms. Dur- 
ing the sweat the painful symptoms gradually subside. During 
the apyrexia, headache; yellowish complexion; belching; loss 
of appetite; nausea; vomiting; constipation; liver and spleen 
swollen; cough; debility; soreness of the spine. 

Opium, sleep during chill, heat and sweat; during sweat he 
still feels burning hot ; children and old people. 

Podoph., chill at 7 a.m., without thirst; heat with thirst; lo- 
quacity during chill and heat ; sweat with sleep ; besides, pain 
or uncomfortable feeling in region of liver which makes him rub 
and stroke this part; diarrhoea during forenoon, frequently 
changing in color. 



Pulsat, the several stages are in general not very violent, and 
mostly unattended by thirst; or thirst only during the heat; or 
the several stages are mixed up; one-sided sweat. The parox- 
ysms set in frequently (though not always) in the evening, and 
last through the night. Characteristic features : tearful and 
peevish; headache during the intermission; face pale or greenish- 
yellow; tongue moist, coated, with bad taste; loss of appetite 
and thirst; nausea; vomiting of slime and bile; spleen enlarged; 
stools diarrhceic, slimy, watery, at night ; profuse, watery urine; 
suppressed or scanty menses ; pain in the chest and cough, with 
pain in the head and pit of the stomach ; frequent palpitation of 
the heart; murmur in the jugular veins; constant chilliness and 
drowsiness ; chlorotic state of the system. 

Rhus tox., before the chill : stretching of the limbs ; yawning, 
with a feeling in the maxillary joint as if sprained; thirst; dry, 
teasing cough, with sweetish, foul expectoration. Chill in some 
parts, and in others heat; or hard chill, with aching in the small 
of the back, drawing in the limbs, and formication in the fingers; 
with restlessness and constant change of position. The heat is 
sometimes before and sometimes after the chill, and often at- 
tended with nettle-rash; pain in the bowels and diarrhoea. The 
following sweat is often profuse and sour. The paroxysms set 
in most frequently in the evening and last through the night ; 
they generally return every day, but seem altered every other 
day. 

Sabad., intermittens incompleta, consisting of chills only; or 
intermittents with predominating chill, and thirst between chill 
and heat; the paroxysms occur precisely at the same hour ; some- 
times they are accompanied with morbid hunger in alternation 
with loathing of food ; during the apyrexia there is constant 
chilliness; sometimes cough with heavy breathing and pain in 
the chest. 

Sambuc, profuse, debilitating sweat, lasts through the apyrexia, 
commences in the face, is worse while the patient is awake, dis- 
appears and changes to a dry heat when he is falling asleep. 

Sepia, chronic cases, with one or the other of the following 
symptoms: frequent flushes of heat; paralytic sinking down of 
one of the upper eyelids; yellowishness of the white of the eyes; 
brownish-yellow saddle across the bridge of the nose; yellowish- 
ness around the mouth; loathing of meat and milk; diarrhoea 
after drinking milk; pain in the liver on moving; bearing down 






INTERMITTENT AND REMITTENT FEVERS. 959 

towards the genitals; palpitation of the heart; tettery eruptions; 
the coldness begins in the feet and rises upwards. 

Silic, in scrofulous subjects. 

Stramon., chill, with icy-cold skin, covered with cold sweat; 
hands and feet livid, head and face hot; vertigo; delirium; epi- 
leptiform convulsions. Wants to be covered during all stages. 

Sulphur, like Sepia, in chronic cases; especially when rooting 
in the soil of suppressed itch or other cutaneous eruptions, with 
one or the other of the following symptoms : heat on the top of 
the head, with cold extremities; red lips; red tip of the tongue; 
wo,rse always after eating; sudden attacks of faintness, with hun- 
ger in the forenoon; costiveness, or else looseness of the bowels 
early in the morning, driving out of bed; hemorrhoidal com- 
plaints; leucorrhcea; cough when lying down in the evening; 
feverishness through the night; complete sleeplessness; itchiness 
of the skin. 

Tart, emet, thirstlessness during chill and fever ; shuddering 
with sleepiness; heat with sopor; sweat with sleepiness; faint- 
ing ; anxiety ; and pain in the lower extremities. 

Thuja, according to Wolf, if Apis is not sufficient, and the com- 
plaint originates in a chronic gonorrhceal contamination of the 
system ; only the uncovered portions of the body perspire ; those 
which are covered are dry and hot. 

Veratr., chill at 6 a.m.; chill and coldness predominate, with 
sticky, cold perspiration and thirst; heat not so marked; the 
sweat profuse, often cold and long-continuing. Attending symp- 
toms : great exhaustion; sinking of strength ; nausea; vomiting; 
diarrhoea, or obstinate constipation ; cramps in the limbs. It is 
indicated, therefore, in the most pernicious kinds of intermittent 
fevers, and those which occur during the prevalence of cholera. 

For still further particulars, I refer to H. C. Allen's and T. 
P. Wilson's Treatises on Intermittent Fever. 



Pernicious Intermittent; Remittent and Continuous 
Malarial Fevers; Congestive Fevers. 

1. Pernicious fevers are characterized by special dangerous, local 
affections of important organs ; they often appear in the form of 
an epidemic ; their paroxysms are usually of the same duration 
as those of a simple intermittent; sometimes they last longer; 
their separate stages may be distinct or ill-defined, with complete 



960 FEVER. 

or incomplete intermittens of various types. When there are 
severe disturbances of the nervous system, one of the most common 
forms is the comatose, or the intermittens apoplectica, with uncon- 
sciousness, stertorous breathing, etc. ; the eclamptic form, mostly 
found among children and puerperal women, with convulsions 
and unconsciousness; the tetanic form, the severest of all perni- 
cious forms, with tetanic spasms; the hydrophobic form, with 
symptoms of hydrophobia. When the alimentary canal is espe- 
cially affected, we have the choloraic form, especially found in 
hot climates, which may increase to an algid intermittent; the 
cardialgic form, with great pains in the region of the stomach ; 
the dysenteric form, with all the symptoms of dysentery ; the 
hemorrhagic form, with haemorrhages from the stomach or bowels. 
The pneumonic and pleuritic forms show serious affections of the 
lungs and pleura, and the icteric form especially attacks the liver. 

2. Remittent and Continuous malarial fevers are frecprently met 
with in the south and southwest of the United States, and in the 
tropical countries. They are all of a malarial origin, which is 
proved by the fact, that they occur exclusively in regions where ague 
prevails, in regions, therefore, which, by their conformation of 
soil and climate, constitute the necessary conditions for the de- 
velopment of the miasma; and it is further proved by the fact, 
that remittent fevers, when improving, gradually change into the 
intermittent type. Hence remittent fevers are onl} r graver forms 
of the effects of the same unknown virus, called miasma, that 
causes the ague, and this corresponds again with the fact, that 
we find remittent fevers oftener in such regions in which the 
common intermittent cases are likewise much more severe than in 
other regions. 

Remittent fever has no apyrexia, but in place of it there is 
merely a slacking off of the fever, which is again succeeded by 
another exacerbation. If it be a continued fever there is not even 
such a remission of its violence. These remittent fevers may be 
divided into three forms : 

1. The bilious or gastric remittent, characterized by commencing 
with a chill, which is followed by a violent fever and many gas- 
tric symptoms; the spleen is swollen; there is slight icterus: 
irregular and whitish stools; herpes labialis ; headache; pain in 
the limbs; dizziness; ringing in the ears: epistaxis : bronchial 
irritation; great debility. It might be confounded with the be- 
ginning of typhus if it were not for the fever blisters around the 



YELLOW FEVER. 961 

mouth and the exacerbations, recurring at first irregularly, but 
later, regularly, gradually assuming a regular intermittent type. 
It may last from several days to three weeks, and corresponds 
to the febris intermittens subintrans. 

2. The typhoid form, gradually loses the remissions and be- 
comes continuous. The patient is delirious or lies in a stupor; 
his tongue is dry and his spleen swollen. In addition to all this 
there may be icterus, or symptoms of pneumonia, dysentery, etc. 
This form lasts from eight to fourteen days, and, if getting bet- 
ter, works over into an intermittent type ; if fatal, the patient 
dies in a comatose condition, corresponding thus to the comatose 
form of a pernicious intermittent. 

3. The gravest form is characterized by a high degree of ady- 
namia, and a tendency to rapid collapse. Such patients are 
deeply apathic from the very beginning, and exhibit functional 
disturbances in almost all organs. Many patients are icteric; 
others bleed from the nose, stomach or kidneys; others show 
albuminuria, or suppressio urinse ; and still others have cholera- 
like or dysenteric discharges from the bowels. Liver and spleen 
are swollen, terminating sometimes in inflammation and suppu- 
ration. The serous membranes show exudates, and the external 
skin is covered with petechise, or destroyed by decubitus and 
gangrene. 

Congestive fever, malignant bilious fever, typho-malarial fever, etc., 
are only other names for the above-described different forms 
of remittent malarial fevers. 

THERAPEUTIC HINTS.— Compare Intermittent Fever. 

The comatose form requires principally Bellad., Opium, Tart, 
emet., Hyosc, Laches., Stramon. 

The adynamic form especially Arnica, Arsen., Bryon., Camphora, 
Carb. veg., Chin, sulph., Ferrum, Hydr. ac, Laches., Phosph. ac, 
Rhus tox., Veratr. 



Yellow Fever. 

The following is from the special report of the Homoeopathic 
Yellow Fever Commission. 

"Yellow fever is a specific disease, entirely independent of 
malaria, occurring rarely a second time in the same person, in- 



962 FEVEK. 

fectious and capable of transmission to any distance by means of 
fomites or infected material. 

" The yellow fever germs, for we accept provisionally the germ- 
theory of the disease, are indigenous to the West Indies and 
perhaps to the west coast of Africa, and have been thoroughly 
naturalized in many localities in the southern portion of the 
United States. They were imported into New Orleans during 
the last quarter of the eighteenth century, and have existed in 
the soil or atmosphere of that place ever since, either in a latent 
or an active condition. Tbey may lie dormant for many years 
consecutively, and they require a concurrence of causes to de- 
velope them into a state of disease-producing activity. 

" Some of the factors which seem to be favorable to the excita- 
tion of the yellow fever germ are the following : 

" Low, swampy ground near the level of a tropical sea. Long 
continuance of very high temperature, following heavy rains. 
Long continuance of south and east winds. Aggregations of 
human beings with the excreta of their bodies in small spaces. 
A crowded and dirty ship may be a nidus for yellow fever, as 
well as a crowded and dirty city. Long continuance of calm 
weather, unbroken by thunder-storms. Exposure of decaying 
vegetable and animal matter to a burning sun. Inefficient drain- 
age and the general accumulation of filth, especially the city 
garbage. Deficiency of ozone in the atmosphere. Pestilential 
exhalations from an upturned soil. 

"When the yellow fever germ has been waked into activity by 
these causes, it may be transported to places where none of them 
exist. It seems that a certain concurrence of several of the above 
factors is necessary to the generation of yellow fever. There is 
probably one combination in one epidemic, and a somewhat dif- 
ferent combination in the next epidemic. An epidemic may be 
mild or severe, according to the number and force of the concur- 
ring causes. There may also be other unknown, but discover- 
able factors, which may be necessary at one time to produce an 
epidemic, and not necessary at another. Xo one of the above 
suggested causes could excite an epidemic by itself, and it is not 
probable that they all ever concurred equally to the formation of 
the disease. The most extensive collections and comparison of 
facts are necessary to illumine the very great darkness which lies 
upon these complex questions. 

"The naturalized yellow fever germs may receive so slight a 



YELLOW FEVER. 9G3 

stimulus as to produce only a few sporadic cases. Or they may 
be vitalized in certain localities to such a degree as to occasion 
quite an outbreak in those localities, not easily communicated to 
other quarters. Or thirdly, the disseminated germs may be vivi- 
fied in all directions, and a general epidemic excited. Or lastly, 
the naturalized germs may lie entirely quiescent, until fresh and 
active germs are brought in from foreign ports, which then act as 
sparks to ignite the inflammable material already existing. We 
thus have four shades or degrees of yellow fever visitation : spo- 
radic cases; local and limited outbursts; epidemics from natural- 
ized germs, and epidemics from importation. 

In sporadic cases and limited outbreaks the specific nature of 
the fever is not clearly brought to light, and it is sometimes 
difficult to diagnose it from the dominant malarial or bilious 
diseases. The imported epidemic, whether from Havana to New 
Orleans or from New Orleans to Memphis, etc., etc., is always a 
more quick-spreading and malignant disease than that arising 
from our naturalized germs. The comparative mildness of the 
late epidemic in New Orleans, is one out of several reasons for 
believing that the disease was of local origin. 

" The yellow fever of domestic origin can only be prevented 
by local sanitary measures. So long as the public authorities 
ignore the crying evils at home, and watch only for the enemy 
at the seaside, we shall continue to be scourged with repeated 
epidemics of yellow fever. Quarantine may or may not keep 
out the tropical foe, but our utmost energies should be concen- 
trated against the enemy which has been domiciliated in our 
households for nearly a century." 

The incubation is short, frequently not longer than a day or 
two ; in some cases fourteen da.ys. 

Its course is an acute one, lasting from three to ten days, and 
consists of three distinct stages. 

1. The febrile stage. — " Very high fever, preceded or not by a 
chill, with extremely severe pains in the head (occipital region 
predominantly), back and limbs. Temperature from 103° to 
107° F. ; great restlessness and malaise, accompanied sometimes 
with mental anxiety and fear of death ; vomiting of ingested 
bile; red, watery eyes; suffused countenance; sleeplessness or 
stupor with intense heat; delirium, sometimes violent, some- 
times muttering ; skin very hot and dry, but very easily excited 
to perspiration." 



964 FEVER. 

2. The stage of exhaustion. — " Passing in most cases by insen- 
sible gradations from a state of great apparent, but of really little 
danger, the patient enters the second stage of yellow fever in 
which he may seem to be doing very well to an inexperienced 
eye, while in fact he may be in an alarming and even hopeless 
condition. The pulse becomes natural again, or weak and ir- 
regular, or in some cases very slow, forty or even thirty to the 
minute. The patient expresses himself as well, wants to eat or 
drink, would commit great imprudence in diet, or talking, or 
throwing off cover, or getting out of bed, if permitted ; apathy, 
indifference, no realization of danger; at night sleeplessness, 
sometimes a terrible pervigilium, restlessness, great nervousness ; 
sour or acid eructations; epigastric pains; tenderness on pressure 
over the liver and spleen; vomiting of ingesta, of a claret-colored 
water, of mucous substances specked with blood, of pure blood, 
of floating shreds like bees' wings, of brown vomit, of genuine 
coffee-grounds, black vomit ; excessive irritability of stomach ; 
black stools ; hiccough. Sudden and unaccountable changes of 
color ; alternate flushings and paleness ; yellow tint of the scle- 
rotica ; increasing yellowness of the surface, even in some cases 
to the deepest jaundice and haemorrhages ; oozing of dark blood 
from gums, nose, eyes, ears; haemorrhage from the uterus, bowels, 
or kidneys ; petechise ; decided albuminuria ; scanty or sup- 
pressed urine, followed by coma or convulsions; secondary fever, 
from local congestions or inflammations." 

3. The collapsed stage. — "Skin of a dirty yellow or almost bronze 
color; large petechial spots; slow oozing of blood from every 
orifice of the body; black vomit; bloody, black, or totally sup- 
pressed urine; extreme jactitation; total apathy or muttering 
delirium ; hiccough ; cold extremities ; feeble and flickering 
pulse ; convulsions ; involuntary discharges of black matter, and 
utter prostration, sometimes with precordial anguish and undy- 
ing irritability of the stomach." (Report of Homoeopathic Yel- 
low Fever Commission.) 

THERAPEUTIC HDJTS.— In the first stage most physicians have 
used Aeon., Bellad., Bryon.; some have recommended Gelsem. and 
Ver. vir., one has called attention to Enpat. perf., Cimieif., Baptis. 
In the second stage all used Arsen., many also Laches., or Crotai, 
and on failure of these remedies Carb. veg. Phosphor, is barely 
mentioned by two physicians. In the third stage the choice lay 



YELLOW FEVER. yt)5 

between Arsen., Crotal, Carb. veg., Hydr. ac, Secale, and Tincture of 
Aeon. 

SPECIAL HINTS.— Aeon., first stage; burning heat and dry skin; 
full, hard, quick pulse ; desire to be uncovered ; great restlessness 
and anxiety; fear of death; dizziness on rising; pain in the fore- 
head and temples; face dark red; eyes injected, sometimes sensi- 
tive to light; lips and mouth dry; great thirst; nausea, vomit- 
ing; heat in the stomach; short, anxious respiration; distress in 
cardiac region; pain in the back and extremities. Useful only 
for a short time; is followed well by Bellad. (Taft, Hardenstein.) 

Apis, pain in forehead and temples, relieved by pressure; burn- 
ing, stinging heat in face with purple color ; dry, swollen and 
inflamed tongue with difficulty of swallowing; strangury, or 
urine scanty and high colored ; sleep disturbed by many dreams ; 
restlessness and delirium. (Angell.) 

Arg. nitr., second stage; vomiting of a brownish mass, mixed 
with cofFee-ground-like flakes. (Holcombe.) Meningeal symp- 
toms. (Hardenstein.) 

Arsen., second and third stage; dull, heavy or throbbing pain 
in the head; face yellowish and livid, or deep, dull red; eyes 
dull and sunken, with dark rings around and yellow sclerotica; 
nose pointed ; nosebleed ; lips and tongue brown or black ; vomit- 
ing, especially after drinking; black vomit; burning or stitching 
pain in the epigastrium and region of the liver; great pressure 
in the pit of the stomach; cramp-pains in the bowels; diarrhoea, 
with tenesmus, or painless and involuntary; bloody discharges ; 
retention of urine; bloody urine; oppression of the chest, with 
short, anxious breathing; pulse irregular, frequent, small, trem- 
bling; internal heat and external coldness of the body, and cold, 
sticky perspiration; stiffness and lameness of the limbs; rapid 
sinking of strength; anxiety and restlessness; wants to go from 
one bed to another; delirium with desire to escape. (Taft, 
Holcombe.) 

Baptis., stupid stare and bewildered look ; cannot collect him- 
self; face dull red, listless, besotted; dry, red tongue, or with a 
dark yellow coating; difficulty of protruding the tongue; fetid 
breath; urine scanty and high-colored; all symptoms worse from 
evening till one o'clock a.m. (Angell.) 

Bellad., first and second stage ; dry, burning heat, with chang- 
ing pulse; sharp, stitching, shooting and throbbing pains iu the 



head and ears; face scarlet red, shining and swollen; eyes red, 
glistening, staring, dilated and oscillating pupils ; carotid arteries 
pulsating; dry, hot tongue and throat; nausea and violent vom- 
iting; cramp-like pain in the stomach; burning and throbbing 
in the pit of the stomach ; urine red or brown ; painful heaviness 
and cramp-like pain in the back, loins and legs ; head and body 
hot, feet cold; delirium, afraid of creeping things. (Harden- 
stein, Taft.) 

Bryoii., first and second stage ; headache in back of head down 
to neck and shoulders, worse from motion ; pain in the eyes when 
moving them ; the eyes are red or dull and glassy, or glistening 
and watery; tongue dry and coated white, or dirty-yellowish, or 
brownish; burning thirst; vomiting worse after drinking; ful- 
ness and oppression in the pit of the stomach and bowels ; pleu- 
ritic pains in the chest with or without cough; pain in the back 
and limbs; yellow skin; anxiety and fear about the future; loss 
of memory; delirium. (Taft, Hardenstein, Angell.) 

Cadm. sulph, when nausea is not relieved by Ipec. or Arsen., in 
first stage. Taste like pitch in the mouth ; salty, rancid belch- 
ing ; nausea in mouth, chest and abdomen, often with pain and 
cold sweat in face ; pain in abdomen ; vomiting of sour, yellow 
and black matter ; burning and cutting in stomach ; vertigo, 
room and bed seem to spin around. (Hardenstein.) 

Camphora, when there is a severe and long-lasting chill at the 
commencement. (Holcombe.) Trembling of the internal parts : 
coldness of limbs. (Hardenstein.) 

Canthar., second and third stage; complete insensibility; 
cramps in the abdominal muscles and legs ; suppression or re- 
tention of urine; haemorrhages from the stomach and intestines: 
cold sweat on the hands and feet. (Taft.) Strangury. (Holcombe.) 

Ckamom., suitable especially for women and children with gas- 
tric irritations. (Holcombe.) An intercurrent remedy for colic. 
(Hardenstein.) 

Carb. veg., like sulphur in cholera, so is, according to Hering. 
Carb. veg., that medicine which, more than any other, corre- 
sponds in the totality of its action, to yellow fever. Taft recom- 
mends it, especially for the third stage, and Howard gives the 
following indications: haemorrhages, with great paleness of the 
face, violent headache, great heaviness in the limbs and trem- 
bling of the body. — The report of the Yellow Fever Commission 
gives the following indications: pupils do not respond to the 



YELLOW FEVER. 967 

light; haemorrhage from the eyes; repeated nosebleed, with 
small, intermittent pulse ; hippocratic face, grayish-yellow ; red 
cheeks, covered with cold sweat; bloody saliva; rancid eructa- 
tions; enormous flatulence; burning in the stomach, with vomit- 
ing of blood; all discharges fetid and offensive; menorrhagia ; 
capillary stagnation; cyanosis; thread-like pulse; sleepless, in- 
tensely restless, from suffocating sensations ; icy coldness of the 
body; ecchymoses. 

Cepa is said to have cured a case of yellow fever when raging 
in Philadelphia; there are a good many symptoms in its patho- 
genesis which might suggest its further application. 

Cimicif., delirium with excessive restlessness; subsultus tendi- 
num ; waking from sleep with a start ; dreams and delirium 
about negroes, devils, etc. (Angell.) Violent pains in small of 
back ; stiff neck ; soreness of all muscles ; pains like electric 
shocks here and there; sharp pains from neck to vertex. Melan- 
choly, indifferent, taciturn. (Report of H. Y. F. Commission.) 

Coloc, for colic and colicky pains. 

CrotaL, is indicated especially by the haemorrhages from the 
eyes, nose, mouth, stomach and intestines. (Bute.) The report 
of the Commission, and Hardenstein, give the following indica- 
tions : delirium with open eyes ; utter apathy ; confused speech ; 
disconnected answers, with coldness of the skin and rapid pulse; 
terrible headache, with red, puffed face; face yellow, or some- 
times of a leaden color; blood flows from the eyes, ears and nose, 
indeed from all the orifices of the body, even bloody sweat; 
thirst ; sour, acrid eructations ; scraping, rancid sensation down 
the oesophagus to the stomach ; extreme nausea and vomiting on 
least exertion ; vomiting of bile, of blood ; swelling of the whole 
abdomen ; enlargement of the inguinal glands ; bloody stools, 
sometimes involuntary; haemorrhage from the urethra; painful 
retention of urine ; menses anticipate; hoarse, weak, rough voice ; 
pains in chest; pulse slower than natural (sixty beats), or inter- 
mitting and scarcely perceptible ; pains in bones; deep yellow 
color of the whole body ; purple spots ; extreme depression of the 
vital powers; spasms; death by syncope; acts more on right 
side. 

Crot. tigl, recommended by Hackett, an allopath ; he saw from 
his doses aggravations, but afterwards rapid improvement. 

Cuprum, Avhen Arsen. does not relieve the vomiting of blood. 
(Kiistner.) 



968 FEVER. 

Eupat. perf., valuable in first stage as an intercurrent remedy in 
cases where the bones ache as if broken, with head and backache, 
thirst and vomiting. (Angell.) 

Gelsem., unconnected ideas, cannot follow any idea for any 
length of time ; if he attempts to think consecutively, he is at- 
tacked by a painful vacant feeling of the mind ; giddiness with 
loss of sight ; indistinctness of vision, or double vision ; fullness 
of head, with heat in face, and cold feet ; pain in back of neck ; 
heavy, dull expression of countenance, and yellow face, or nausea 
and paleness. Sticky feeling in mouth ; fetid breath ; tongue 
coated whitish or yellowish ; dryness and burning in throat ; 
sour eructations ; pulse frequent, full, but soft. As soon as he 
goes to sleep, he is delirious. (Angell.) 

Ipec, in tbe first stage: dizziness, chilliness, pain in the back 
and limbs, uncomfortable feeling in the epigastrium, with nau- 
sea, vomiting and great weakness. (Taft.) To be followed by 
Cadmium sulph. if relief is not soon attained. (Hardenstein.) 

Laches., quite important in any of the stages. Kiistner gave it 
also after previous abuse of mercury or quinine. The report of 
the commission, and Hardenstein, give the following indications : 
delirium at night ; loquacious, disposed to quarrel ; slow, diffi- 
cult speech; drowsy; rush of blood to the head; red face; yellow 
conjunctiva ; yellow or purplish tint of skin ; blood dark, non- 
coagulable ; small wounds bleed much ; perspiration stains yel- 
low ; lips dry, cracked and bleeding ; tongue heavy, trembling, 
dry and red, cracked at tip ; tip red, centre brown ; difficult 
speech ; sour eructations ; heartburn ; nausea after drinking ; 
vomiting, with palpitation ; dyspnoea ; anxiety about the heart : 
cannot lie on left side; irregular, weak pulse; urine almost 
black ; persistent sleeplessness ; fainting ; trembling all over ; 
sudden flushes of heat ; sensitiveness about the neck and pit of 
stomach against any pressure : worse when waking ; better after 
nourishment. Acts more on left side. 

Mercur., yellow skin ; red, injected eyes, sensitive to light ; pa- 
ralysis of the one or the other limb ; tongue moist, coated, thick 
and white, or dry with brown slime; pulse irregular, quick, 
strong, and intermitting, or soft and trembling. Drowsy or sleep- 
less from nervous irritation; tired and weak; rapid sinking of 
strength ; dizziness and violent headache ; violent convulsive 
vomiting of slime and bilious matter ; burning pain and sensi- 
tiveness of the stomach ; constipation or diarrhoea of slime, bile 



YELLOW FEVER. 9G9 

or blood ; coldness of the extremities with cramps. Great irrita- 
bility of all the organs; anxiety and restlessness; weak memory; 
fears; discouragement; crossness. (Taft.) 

Nux vom., after allopathic drugging, or in persons accustomed 
to drinking strong liquors. According to Taft : yellow skin, pale 
or yellowish face, especially around the nose and mouth ; eyes 
injected, yellow and watery; dark rings around the eyes; tongue 
slimy or dry, cracked and red on the edges; thirst for beer or 
stimulating drinks ; burning in the stomach ; pressure or cramp- 
pain in the stomach; vomiting of sour, bilious, or slimy sub- 
stances; hiccough; dizziness or headache; trembling of the 
limbs ; cramps in different parts of the body ; contractions of the 
abdominal muscles; thin, slimy, bilious or bloody stools; burn- 
ing pain in the neck of the bladder, with difficult urination ; cold- 
ness, lameness and cramps in the legs ; cold feet. Excessive 
anxiety ; fear of death ; despondency or loss of consciousness and 
delirium, with moaning and groaning. 

Phosphor., hemorrhagic form, with petechial spots, or with 
meningitis, or especially pleuritic pains after Bryon. (Harden- 
stein.) "Its power of producing acute yellow atrophy of the 
liver, fatty degeneration, malignant jaundice, albuminous urine, 
the hsemorrhagic diathesis, and many of the symptoms of Arsen. 
and Crotal., shows that it is a remedy of great homoeopathic ap- 
plicability to yellow fever." (Report of Commission.) 

Rhus tox., according to Taft : dirty yellow color of the body ; 
glassy, sunken eyes; dry, black tongue; talkative delirium, or 
coma with rattling respiration; constant groaning; torturing 
pain and burning in the stomach; nausea; vomiting; paralysis 
of the lower extremities; cramps in the abdomen; colic; diar- 
rhoea ; difficulty in swallowing ; constant restlessness and tossing 
about. According to Angell : bright redness of face (in first 
stage), or pale and sunken face, with pointed nose; epistaxis; dry- 
ness of mouth and throat; dry cough and red tongue, or dark 
brown (mahogony) or black ; cracked tongue, unable to protrude 
it; eructation and rumbling in abdomen causing great distress; 
diminished urine; sleeplessness. 

Sulphur, melancholic ; fearful ; undecided ; sad ; absent-minded ; 
dizziness; headache; face pale or yellowish; eyes red or yellow- 
ish ; itching and burning in the eyes ; noises in the ears ; tongue 
dry, red, or with white or brown coating; aphthae in the mouth; 
nausea with trembling and weakness; vomiting of sour, or bilious, 



970 FEVER. 

or bloody and black masses; pressure in the stomach; pain in 
the back and loins. (Taft.) 

Tart, emet, continuous nausea with vomiting, or vomiturition 
with perspiration on forehead; shuddering; attacks of fainting 
and trembling; great prostration. (Angell.) 

Verbena Jam. The juice of the leaves of this plant, the species of 
which is not properly given, is said to have cured a number of 
the most desperate cases. 

Veratr., according to Taft: yellowish or bluish face, cold, and 
covered with a cold perspiration; eyes dull, yellowish, watery ; 
deafness; lips and tongue dry, brown, cracked; difficult swallow- 
ing; hiccough; great thirst; vomiting of bile or blood ; burning 
in the stomach; coldness of the hands and feet; trembling and 
cramps of the hands, feet, legs, and abdomen; diarrhoea, thin, 
blackish or yellowish; pulse small, scarcely perceptible, inter- 
mitting. Great exhaustion; vertigo; fear; despondency; rest- 
lessness; loss of consciousness; coma or delirium. According to 
Angell : after purging from castor oil ; vomiting of slime and 
diarrhoea, sometimes involuntary stools ; hopelessness of life. 
According to Hardenstein : in first stage trembling and jerking 
of external parts; coldness all over the body. 

Ver. vir., intense fever with occipital pains, and vascular and 
nervous erythism, threatening convulsions, especially in children ; 
development of local inflammations; prsecordial distress; vomit- 
ing with cold sweat on the face ; great and sudden changes in 
the pulse. (Report of Commission.) 

Aside from these remedies we find recommended : 

For nausea: Apomorph., Kreosot., Hydr. ac, Lobel. inn. 

For nervousness and slee})lcssness : Coffea or Bellad., Opium, 
Daphne ind., Sepia. 

For hemorrhages : Plumb, ac, 5^ of a grain (Angell), Sulph. ac, 
Tereb., Millef., Eriger., Lycop., Arnica, Sabina, Secale, Hamani., 
Thlaspi bursa pastoris. 

For albuminuria: Euonymin, Helon., Cuprum, Merc. corr. 

For retention of urine, with delirium and convulsions: Hyosc, 
Opium, Stramon., Plumbum. 

For difficult 'urination and tenesmus: Lycop., Tereb., Chimaph., 
Apis, Apocyn., Prunus spinosa, Cann. ind.. Sulphur, Citric ac. 

For cerebrospinal symptoms: Glonoin., Corall., Cicuta. Zincum. 

During convalescence: Calc. carb., China, Hepar. (Report of 
Commission, Hardenstein.) 



DENGUE OR BREAK-BONE FEVER. 971 

Dengue or Break-Bone Fever. 

Dr. R. D. Arnold, of Savannah, says (Identity of Dengue and 
Yellow Fever, 1859): "The dengue is a milder type of yellow fe- 
ver, consisting of violent pain of the head and loins, with a sort 
of rending of the bones of the extremities, of a single fever-parox- 
ysm of variable duration, which terminates into a cutaneous erup- 
tion, similar to that of scarlet fever." Dr. Waring, of Savannah, 
says: "At first the correspondence between yellow fever and den- 
gue would be complete, and each would seem to be preceding to 
a similar conclusion, when abruptly and without perceptible cause, 
it appears to sweep the disturbances it has excited into the stom- 
ach, and ends in black vomit, while the other precipitates itself 
upon the skin and eventually in a fugitive inflammation." Zuel- 
zer in Ziemssen's Encyclopaedia says : " The name dengue is ap- 
plied to an acute disease, which mostly occurs as an epidemic in 
hot climates, seldom sporadically, and the course of which, after 
a sudden onset or after slight prodromata lasting several days, 
consists of two paroxysms accompanied by fever, either following 
immediately one upon the other, or after an intermission of one, 
two or three days. But the paroxysms are essentially different 
one from the other ; the first is characterized by continuous high 
fever, reaching its height within the first 12 to 24 hours (temper- 
ature 106.7 and 107.6° F., and pulse from 120 to 140 per minute), 
and numerous exceedingly painful swellings of the joints, which 
interfere with motion, also, more rarely, by an exanthem. These 
symptoms subside after two or three days, simultaneously with 
the sudden outbreaks of a sweat, or epistaxis, or a diarrhoea, which 
is often critical. 

The second febrile stage, which lasts from two to three days, is 
marked by a remitting fever, and a more or less extensive blotchy 
or uniform, non-elevated, rose-red eruption and great itching of 
the skin, also less frequently by swelling of the joints. 

The subsequent recovery is gradual, and accompanied by de- 
cided desquamation. Its course is generally accompanied by 
great loss of appetite, restlessness and sleeplessness. More seri- 
ous brain-symptoms are absent. 

The disease attacks all ages and both sexes ; with adults it ter- 
minates in recovery, with children it is occasionally dangerous. 
It sometimes leaves behind long-continued and painful swellings 
of the joints, diarrhoea, emaciation and great debility. Relapses 



972 FEVER. 

also occur. It is not yet determined whether the disease is con- 
tagious or occasioned by miasmatic influences." 

Typhus. 

Typhus means literally, smoke, stupefaction. In the course of 
time this word has been used to signify different pathological 
affections, all of which, however, were characterized by a dry 
tongue, stupor, delirium and great prostration. Nowadays it has 
become usus to call typhus only three forms of low fever, namely : 
the typhus exanthematicus, or petechial typhus, which is character- 
ized by a peculiar eruption, and the typhus abdominalis, or ileo- 
typhus, which is characterized by a peculiar diseased state of the 
small intestines, and in this country best known under the name 
of typhoid fever and relapsing fever. 

Typhus Exanthematicus, Petechial Typhus. 

This form is also known under the name of Jail-fever, Ship-fever, 
or Camp-fever. Its immediate Cause is unknown ; recent authors, 
however, agree that it is spread by a typhus-germ. Its con- 
tagiousness is great, and increases with the duration of closer 
contact with typhus patients, therefore assistants and nurses in 
hospitals are much more frequently attacked than the visiting 
physicians and students ; and where many persons are confined 
to a limited space, e. g. in prisons, on shipboard, in camps, etc., 
the pestilence spreads rapidly to those thus confined. The dis- 
ease germ is carried by every article which has been in contact 
with diseased persons, by water, if polluted with excrements 
from patients, by air, if contaminated with diseased exhalations, 
etc. Famine, atmospheric and telluric conditions, damp, marshy 
soil, etc., favor its development. It attacks rich and poor of both 
sexes and of all ages, but most frequently those between the ages 
of 20 and 40 years. Ordinarily, it occurs but once in a lifetime. 
Epidemics have most frequentty raged in Ireland, but also in 
other parts of the globe. 

The time of incubation varies from a few days to a week and 
longer, and is attended with various disturbances, none in any 
way characteristic of the complaint. 

The stadium invasionis commences in many cases with a severe 
chill, or with several slight chills, sometimes repeated at inter- 



TYPHUS EXANTHEMATICUS. 973 

vals during the first day, which are followed by a continuous 
great heat, amounting already on the third or fourth day to 103° 
or 104° F. in the morning, and to 104° or 105.8°, rarely to 107.6° 
F. in the evening. The patient is at once stricken down by a 
sense of great weakness and debility, and complains of heaviness 
or pain in the head, which at times is somewhat ameliorated by 
a spontaneous bleeding from the nose; of vertigo, flickering 
before the eyes and ringing in the ears. His hearing becomes 
impaired ; his muscles are sore and painful, and on motion his 
limbs tremble. He lies apathetic on his back, talks deliriously 
while being awake, or mutters in his sleep. Others, however, 
are intensely excited, almost wildly, scarcely to be held in bed. 
With all this we observe various catarrhal affections of the eyes, 
nose, throat and chest, which latter is the most constantly affected 
part, manifesting itself by a harassing, rough cough, with a 
scanty, tough, sometimes bloody expectoration. Auscultation 
reveals numerous rhonchi. The tongue looks, at this stage, 
white, with a pappy taste; there is, at times, nausea, vomiting 
and diarrhoea. This state of things lasts about half a week, when 
between the third and fifth days, scarcely later than the seventh 
day, the second stage, the stadium eruptionis et florescentise com- 
mences. We now observe the breaking forth of a rash — roseola 
spots, greatly resembling that of measles — first on the trunk and 
gradually spreading over the entire body. During the first few 
days these spots disappear on pressure, later, when exudation of 
blood-corpuscles or coloring matter has taken place, they fade no 
longer under pressure; they remain till toward the end of the 
second week. True petechia?, on the contrar}^ are spotted ex- 
travasations of blood from the beginning; they remain longer 
and disappear more slowly, and may reappear after the roseola 
has gone. The appearance of this eruption does not in the least 
ameliorate the situation of the patient; on the contrary he grows 
worse all the time ; his sensorium becomes more clouded ; he is 
unable to think, gives slow, incoherent answers, is in constant de- 
lirium, either of a mild or raving nature, with constant attempts 
to jump out of bed and run away. After recovery the patient 
scarcely ever remembers anything of this stage. 

The difficulty of hearing increases ; the tongue grows dry, and 
is covered with a brownish coating, and the respiration, although 
the cough has lessened materially, is quick and superficial, with 
increased rhonchi and a dull percussion-sound on the dependent 



974 FEVER. 

parts of the thorax. There is almost always constipation at this 
stage, with involuntary discharge of urine. The heat retains its 
height to the latter part of the first week, when in light cases it 
generally slackens off a little, and by the seventh day shows an 
appreciable remission for the first time. In severe cases, however, 
the temperature of the body increases during the second part of 
the first week, and shows no remission on the seventh day. The 
spleen is considerably enlarged toward the end of the first week, 
and the eruption commences to grow more livid with the com- 
mencement of the second week. Now the patient lies flat on his 
back, with his eyes half-closed, and his hands on his genitals, in 
deep stupor, out of wdiich he can scarcely be roused; he mutters 
single, unintelligible words, draws faces according to the nature 
of his ever working imagination, gesticulates, catches at some- 
thing in the air, or picks the bed-clothes, tries to rise or to put 
his feet out of bed, in fact, his mind seems to be constantly busy 
at something, although entirely disconnected with the world 
around him. He manifests no desire for drink, which, however, 
is taken wdien offered, though sometimes with great difficulty, as 
the tongue is parched and trembling and the swallowing difficult. 
The teeth and gums are covered with sordes, the nostrils appear 
blackened as by soot, and the breath exhaled has a terrible smell. 
By this time the petechial eruption is joined by the breaking 
forth of a miliary eruption; the bronchial catarrh may increase to 
pneumonia or collapse of the lungs, and a number of cases, even 
light ones, are complicated with parotitis. The fever increases in 
all cases with the beginning of the second, may there have been 
a remission on the seventh day or not. In light cases, however, 
this aggravation is not very severe, nor does it last more than a 
few days, while in severe cases it reaches up to 100.8° or even 
107.8° ¥., lasting to the end of the second week, even to the six- 
teenth and seventeenth day of the disease. 

The third stage, or the stadium criticum, commences almost al- 
ways in the latter part of the second week, or, in severe cases, in 
the first days of the third week. The change sets in remarkably 
quick, often in one single night, in which the patient at once, 
after so many sleepless nights, enjoys a deep, quiet sleep, out of 
which he awakes for the first time conscious again, but without 
remembrance of what has passed. The temperature has sunk, 
perhaps, two degrees and the frequency of the pulse, perhaps, 
twenty to thirty beats per minute; instead of the pungent heat, 



TYPHOID FEVER. 975 

the body is in a gentle perspiration and the roseola-spots appear 
much paler. Now convalescence commences, which goes on, 
however, quite slowly. The crisis is accompanied by the forma- 
tion of sediments in the urine, an increase in its quantity, a dis- 
appearance of the albumen, and a normal amount of urea and 
chlorides, though these changes occur slowly. Often recovery is 
delayed or even frustrated by a renewance of a slow fever, which 
takes away the last strength of the patient, or other sequelae re- 
tard its progress, among which the most frequent are: inflam- 
mation and suppuration of the parotid glands, pneumonia, pleu- 
risy, diphtheritic or follicular inflammation of the intestines, nu- 
merous furuncles, ecthyma pustules or large abscesses in the 
subcutaneous or intermuscular cellular tissue ; even thrombi in 
the veins of the legs and their consequences. 

There have been observed light, abortive cases of exanthematic 
typhus, in w r hich it did not even come to an eruption or to an en- 
largement of the spleen, and where the whole morbid process was 
finished in two weeks. Loss of hair is not uncommon after an 
attack of typhus. 

THERAPEUTIC HINTS.— See the following chapter. 

Typhoid Fever, Typhus Abdominalis, Ileo-Typhus. 

This form is also known under the name of enteric fever, mesen- 
teric fever, enter o-mesent eric fever, abdominal nervous fever, pythogenic 
(produced by putrefaction) fever. Contrary to typhus this fever 
is never directly transmitted from person to person. It is not 
like typhus a purely contagious disease, but belongs to the mias- 
matic-contagious diseases. According to numerous observations 
its poison, though originating in the typhoid patient, is trans- 
ported and developed in the excrements when they are left for 
some time to themselves, as in dirty linen (fresh dejections are 
handled by physicians and nurses w T ith impunity), or still more 
abundantly when they are collected in privies, sewers, or ground 
already saturated with organic substances. Thus it seems that 
the poison, in order to become active, has to go through a certain 
stage of development outside of the body, where it retains its 
vitality for a long time. From such beds of developed poison 
infection can be carried to whole communities by the inhalation 
of gases arising from sewers, etc., and by drinking w r ater polluted 



976 FEVER. 

with excrementitious matter, in which the specific poison of 
typhoid fever has been developed. Poisoned water can be disin- 
fected by boiling. The period of incubation seems on an average 
about three weeks, though in isolated cases it may be only two 
weeks, and in others last as long as four weeks. In large cities 
sporadic cases happen at any season; epidemics of typhoid fever 
occur most frequently from August to November. 

The greatest individual disposition to take the disease seems to 
prevail between the ages of fifteen and thirty years. Children 
less than one year old are very seldom attacked ; after this up to 
fifteen years the predisposition steadily increases, while after the 
age of thirty years it steadily decreases. On the whole the disease 
attacks by preference the strong and healthy; it avoids those 
already suffering with chronic ailments, and also pregnant and 
puerperal women, and those who' are nursing infants, although 
exceptions exist. Persons who have passed through the disease 
once before are not always exempt from another attack, and 
"real recurrences, that is a new attack coming on soon after the 
first has run its course, and relapses before the completion of the 
disease are often seen." (Liebermeister.) 

The principal anatomical changes which typhoid fever produces, 
are: catarrh in the chest, even in the finest bronchial tubes; en- 
largement of the spleen to double and even six times its natural 
size; and ulceration of the small intestines. These last, more or less 
constant, anatomical changes have given rise to the appellation of 
ileo-tijphus. Rokitansky distinguishes four stages of this typhoid 
process upon the mucous membrane of the small intestine?. 

1. The congestive state, by which the whole membrane appears 
swollen, injected and covered with slime, w T orse so, however, on 
its lower portion in the neighborhood of valvula Bauhini. 

2. The state of infiltration, by which the general redness and 
swelling gradually disappear and become concentrated to the 
solitary and Peyer's glands in the lower part of the ilium. 

3. The state of softening, by which the swelling of the glands is 
absorbed, or the glands burst and become covered with a dry, 
crumbly crust, or they burst and discharge their contents with- 
out getting covered with a crust. 

4. The state of ideeration, by which the affected glands suppu- 
rate and form the typhoid ulcer. These ulcers are round when 
originating out of a solitary follicle, and elliptic when originating 
out of Peyer's plaques; their size varies from that of hemp-seed or 



TYPHOID FEVER. 977 

pea to the size of half a dollar. Their basis is the submucous 
cellular tissue which lines the muscularis of the gut. 

The Symptoms and Course of typhoid fever are the following: 
The patient has generally several days previous to the attack, a 
sense of general indisposition, weakness and debility, with head- 
ache, dizziness and soreness of the limbs, and sometimes repeated 
attacks of bleeding from the nose, or none of all. The attack 
itself begins almost always with a more or less violent chill, or 
repeated chilly sensations, but sometimes without a chill. It is, 
therefore, not always possible to fix accurately the time of the 
disease. The chill is followed by heat, which keeps a regular, 
quite characteristic, typical rise and fall every day for the first 
three or four days, "rising about 1.8° to 2.7° F. from morning till 
evening, and falling from every evening till next morning about 
.9° to 1.3° F., so that on the third or fourth evening a temperature 
of 104° F. is reached, or a little exceeded. The formula of this 
ascent is nearly as follows : 

First day, morning: 98.6° F., evening : 101.8° F. 
Second day, " 100.21° F., " 102.56° F. 

Third day, " 101.66° F, " 103.64° F. 

Fourth day " 102.56° F., " 104.54° F." 

This pyrogenic course in the initial stage of typhoid fever is so 
decisive a test for its diagnosis, that Wunderlich further says: 
" If the temperature of the second, third and fourth evenings is 
only approximatively normal; if the temperature of the first 
three evenings, or of two of them, is of the same height; if the 
temperature of two out of the first three mornings is alike; if the 
temperature of the first two days rises to 104° F. or more ; if the 
temperature retrogrades only once on any of the first four morn- 
ings and evenings: in everyone of these cases we may or must 
exclude typhoid fever from our diagnosis; and contrarily, said 
diagnosis is the more certain as the course of the temperature of 
the first four days comes nearer to the above formula." 

"Meanwhile, exceptions must not be overlooked. The rise 
ma}'' be completed in two days, or protracted five ; both forebod- 
ing a severe course, the latter a delay in the favorable turn (crisis 
or lysis) till the middle of the third week ; the temperature may 
return to normal the second morning, and be succeeded by a 
greater rise the second evening; the rise of the first and second 
day being less, that of the third and fourth will be much more ; 
62 



978 FEVER. 

the height reached the third and fourth day is not always 104° 
F., but may be a few tenths less or more by a whole degree, 
105. S° F. AVhen the typhoid fever is secondary to another dis- 
ease its initial is obscure, often unrecognizable." 

"In the second half of the first week, and the first half of the 
second, the course of the temperature is quite uniform, but can- 
not help the diagnosis. At this time the maximal height, 104 to 
106.7° F., is rarely reached more than once between noon and 
evening of the fourth or fifth day ; meantime the morning tem- 
perature is .9° to 2.7° F. lower than the evening's — one remission 
may be accidentally even lower." (TVunderlich's Thermometry, 
by Seguin, page 123.) 

The course of the temperature during a whole attack may be 
characterized in this way, that in the first week it rises steadily, 
in the second week it is continuous, having the same maximum 
and minimum every day, in the third week it becomes remittent, 
showing greater remissions in the morning although the exacer- 
bations in the evening keep still the same height, while in the 
fourth week the remissions become more marked and the exacer- 
bations gradually lower. (Liebermeister.) 

With the temperature rises also the pulse, amounting generally 
during the first week from ninety to one hundred beats per min- 
ute ; sitting up, bodily exertion, or mental excitement, is apt to 
accelerate it considerably, even to twenty or thirty beats. 

With all this the patient complains of great weakness and pros- 
tration, severe headache, dizziness, flickering before the eyes, and 
ringing in the ears; his sleep is restless and disturbed by tire- 
some dreams, sometimes of the same thing over and over again; 
he calls out in sleep or talks incoherently. AVhen awake he is 
fully conscious, but indifferent, answering questions slowly and 
reluctantly. His thirst is great, his appetite gone, and his taste 
pappy, disagreeable. The bowels are during the first days fre- 
quently constipated, but change towards the end of the first week 
to diarrhoea. There is in many cases repeated bleeding from the 
nose, and already at this time a catarrhal irritation in the chest. 
The face is flushed, especially the cheeks look dark red as long as 
the patient lies quietly on his back, but it turns pale and sunken 
when he sits up a while. The tongue is soft, flabby, showing the 
imprints of the teeth, and is covered by a slight whitish fur, 
which gradually is thrown off, leaving the tongue moist, smooth, 
and red, as though it were covered with a fine gold-beater's skin; 






TYPHOID FEVER. 979 

it soon, however, grows dry. In cases where the tongue is thickly 
coated, this covering commences to disappear either on the tip 
and edges, whereby the yellowish- white coating becomes encircled 
by a gradually broader-growing,, deep, red belt, or it disappears 
at first in the centre, and constitutes that well-known, dry, red 
streak in the middle of the tongue, which is frequently broader 
at the point of the tongue, and forms, in this way, a kind of tri- 
angle, with its base down at the tip. 

The abdomen at this time appears somewhat bloated and is 
sensitive to strong pressure. A deep pressure upon the ileo-csecal 
region may cause a gurgling noise in that region, especially if 
there be already diarrhoea present. The spleen is swollen, which 
can be detected by percussing the patient when he lies upon his 
right side. Finally, there appear toward the end of the first 
week, single, pale, reddish, lentil-sized roseola-spots upon the epi- 
gastrium and adjacent parts of the chest and abdomen. 

In the second week the temperature of the body ranges between 
104° F. and more; towards morning there is only a slight remis- 
sion, and the pulse grows softer r weaker, and more frequent, from 
110 to 120 beats, revealing more or less weakness of the heart. 
The dizziness increases, the ringing in the ears changes to hard- 
ness of hearing, which is generally dependent upon a catarrhal 
affection of the Eustachian tubes and tympanum. The expres- 
sion of the face becomes more and more stupid, and the indiffer- 
ence of mind increases. By-and-by the consciousness of the pa- 
tient becomes clouded and he sinks gradually in a state of som- 
nolence and stupor. Although the tongue is as dry as "chip," 
yet he utters no desire for drink; takes it, however, when offered, 
very greedily. When asked to show his tongue, he does not 
seem to comprehend at first, but finally, with great effort, he 
brings it forth, pointed and trembling. Stool and urine pass off 
involuntarily. The patient lies always on his back, and having 
lost consciousness of all muscular power, the body follows its own 
weight and the patient slides gradually down "in bed, without any 
effort of his own to change this position. The mental operations 
are still going on ; we see it on the now and then trembling lips, 
as efforts to speak, and in the low murmuring of unintelligible 
words now and then. This is febris nervosa stupida. 

Other patients, although likewise mentally disconnected with 
the exterior world, neither knowing nor understanding what is 
going on about them, manifest a vivid, dreamful perturbation of 
the mind. 



980 FEVER. 

They are in constant agitation, throw off the covers, try to get 
out of bed and to escape, talk loud or lisp some unintelligible 
words, gesticulate and become angry when interfered with. 
Their obstinacy in gaining their imaginary ends is sometimes 
astonishing, when all at once it changes to some other object. 
In other cases there seems to be no intelligible connection be- 
tween the constantly-changing phantasmata, with which they 
seem to be haunted. This agitation of the mind is generally 
greatest during the night. This is febris nervosa versatilis. There 
are again cases where both of these states make a regular turn ; 
the febris stupida prevailing through the day, and the febris ver- 
satilis through the night. 

During this week the bowels are almost always loose, owing 
to the catarrhal affections of the intestines; the cheeks have a 
brownish-red or bluish color ; the eyelids are half-closed ; the 
conjunctiva is injected ; the nose is thoroughly dry, and the nos- 
trils are blackened as of soot. On the gums and teeth we observe 
sordes ; the tongue is covered with a brownish crust, which gradu- 
ally grows black from the admixture of blood ; it is stiff, making 
swallowing quite difficult. The abdomen is inflated like a drum; 
the spleen has grown still larger, and the roseola-spots have, in 
some cases, likewise increased, and are joined by numerous suda- 
mina. On the chest, physical examination reveals solidification 
of the dependent parts of the lungs, and far-spread catarrhal 
affections. There is a less full percussion sound, weak vesicular 
breathing, fine, bubbling rattles in the dependent parts, and loud 
rhonchi everywhere else. 

The third week does not bring any amelioration as yet. The 
temperature of the body is still on the increase, and the morning 
remissions are quite indistinct. Only where the case turns favor- 
ably, there is in the second half of the third week a decided im- 
provement in this respect. While the evening temperature still 
rises to 104° or over, the morning temperature shows greater re- 
missions. 

The prostration reaches, in this week, its climax; the patient 
slides down in bed; there is a constant jerking of the tendons; 
somnolence and stupor are complete, and stools and urine are 
passed unconsciously, or the urine is retained in consequence of 
a paralysis of the detrusor vesicae ; the roseola-spots commence 
to get paler, the sudamina increase more and more, and in some 
cases there appear petechia?. To all this associates an erythema 



TYPHOID FEVER. 981 

in the region of the sacrum, which, by throwing off the epidermis, 
is soon converted into a bed-sore — decubitus. This is, indeed, the 
week when the mortality of typhoid patients is the greatest, while 
in favorable cases its latter part is the turning point. We observe 
then a gradual abatement of all the above-detailed symptoms. 
The stupor changes into a natural sleep, consciousness gradually 
returns ; diarrhoea, respiration, pulse, countenance, all improve. 

This improvement continues in the fourth week, or in some in- 
stances commences then, and finally passes over into the state of 
convalescence. During this time nearly all the patients lose 
their hair, which, however, is soon followed by a new crop. 

This is about the course which a majority of typhoid fever cases 
run. Besides this, however, there are a number of variations, of 
which the following are the most important. 

The Abortive typhoid fever is, in every respect, much lighter, and 
corresponds to the " gastric fever or nervous fever" of older writers. 
Although it shows all the symptoms of a regular typhoid fever, 
yet they are all much milder; the temperature of the body never 
reaches such an intensity, and already on the eighth or ninth 
day there is a considerable morning remission, which sinks at 
the end of the second or during the third week to a normal state, 
with only slight aggravations in the evening. Still the patients 
gain their usual strength quite slowly. 

The Typhus ambulatorius is a peculiar form, corresponding to 
the " walking cases " of yellow fever, by which the patient com- 
plains only of general debility and exhaustion, but still attends 
to his business, until all of a sudden he sinks under the signs of 
perforation of the intestines or intestinal haemorrhage. In such 
cases it seems that the poison has localized exclusively in the in- 
testines, without affecting the general circulation. 

The Typhus tumultuarius, on the other hand, sets in at once so 
violently that the temperature of the body rises already in the 
first week to 106° F. and above, and the pulse to 120 and 130; 
all other symptoms are correspondingly severe, so that the dis- 
ease reaches its climax towards the end of the first or the begin- 
ning of the second week. Such cases are mostly fatal at this 
early period, or the symptoms grow milder again in the second 
week, and take then the usual course. 

The Pneumo-typhus and Broncho-typhus are forms in which the 
poison seems to localize principally in the chest, causing hypo- 
stasis of the lungs, pneumonia, or violent bronchitis, while the 



982 FEVER. 

characteristic affections of the small intestines are comparatively 
light, or even wanting. 

Cardiac weakness, the result of degeneration of the muscular 
tissue of the heart, is responsible in part for the tendency to dis- 
integration which is found in all tissues of the body, and is the 
most frequent immediate cause of death, and consequently " the 
observation of the pulse is of even greater significance than the 
observation of the temperature for the prognosis of some cases. 
So long as the pulse is, in a measure, strong, and its frequency 
only moderately increased, no immediate danger exists on this 
side, even when the constant elevation of temperature is very 
considerable." (Liebermeister.) This degeneration of the heart- 
muscle exists, to a greater or less degree, in all severe cases with- 
out exception. 

Parenchymatous degeneration of the liver is also found in every 
severe, prolonged and fatal case of typhoid fever, and may reach 
so high a grade as to present a distinct complication, a group of 
symptoms characteristic of icterus gravis or acute yellow atrophy 
of the liver. Still, jaundice occurs less frequently during typhoid 
fever than in pneumonia. 

Parotitis begins most frequently during the third or fourth 
week, is always confined to the most severe cases only, and is a 
bad prognostic sign. 

In still other cases the normal progress of the disease is inter- 
rupted by an intercurring perforation of the intestines, when the 
typhoid ulcers eat through the muscularis and serosa of the gut. 
This is always followed either by a partial or diffuse peritonitis, 
the symptoms of which compare under the corresponding chap- 
ter. The most reliable sign, however, of perforation, during 
typhus, is tympanites or the sudden escape of gas into the perito- 
neal sac, which presses the liver back from off the thoracic wall, 
and causes, on percussion, in place of the dull liver sound, a clear 
tympanitic sound. 

Or the natural progress of the disease is interrupted by an in- 
tercurring hemorrhage from the bowels. This takes place either in 
consequence of arrosions of blood-vessels near the ulcers, or in 
consequence of the bursting of overfilled capillaries. It causes 
bloody stools, and, if profuse, collapse and a sudden sinking of 
the temperature, which sometimes restores consciousness for a 
while, but generally ends fatally, in consequence of the exhaus- 
tion which it produces. Less dangerous are the intercurring 



TYPHOID FEVER. 983 

profuse haemorrhages from the nose, which take place sometimes in 
the second or third week of typhus, and the haemorrhages from the 
womb in female patients. But as both are the consequence of a 
highly debilitated state of the system, none of them can be con- 
sidered as a favorable sign. 

Or the whole course of the disease is protracted by the slow 
healing process of the intestinal ulcers. In such cases we find the 
typhus followed by a low, asthenic fever for weeks afterwards, or 
in fact there is no cessation of the fever; the sensorium remains 
clouded ; the weakness increases ; the emaciation grows excessive ; 
the bed-sores enlarge; any part of the body, wherever its own 
weight rests upon, shows the signs of decubitus. Many of these 
patients die about the fifth or sixth week, as such a far-spread de- 
cubitus alone seems to be sufficient to consume the little strength 
that is left. 

As Sequelae of typhus may be mentioned : neuralgia, partial 
paralysis, partial anaesthesia, mental disturbances, tabes, anaemia 
and hydrsernia. It is not unfrequent that, during the period of 
reconvalescence, phthisis pulmonalis is developed. 

THERAPEUTIC HINTS.— Agar, muse, constant delirium, attended 
with attempts to get out of bed, with a tremulous propulsion of 
the tongue and a general tremor of the whole body. (G. C. Hib- 
bard.) Desire for alcoholic drinks, which are easily borne. It 
suits well typhoid fever in drunkards. (A. Charge*.) 

Alumen, great masses of coagulated black blood pass from the 
anus in the third week of typhus, with signs of the greatest 
exhaustion. (Hering.) 

Alumina, is often indicated when Bryon., though indicated, does 
not act deep enough. (Gosewitsch.) 

Apis, according to Wolf, in the presence of: apathic conditions, 
unconsciousness, stupor, with murmuring delirium, hardness of 
hearing, inability to talk and to put out the tongue, which is 
cracked, sore, ulcerated or covered with vesicles; difficulty in 
swallowing, great soreness and bloatedness of the abdomen ; 
constipation, or frequent, painful, foul, bloody and involuntary 
discharges from the bowels; unconscious flow of urine; dry, 
burning skin, or partial, clammy sweats; trembling and jerking 
of the limbs ; white miliary eruption on the chest and abdomen, 
greatest weakness and sliding down in bed ; frequently changing, 
weak and. intermitting pulse. 



984 FEVER. 

Arnica, stupefied condition ; sits as if in thought, yet thinks of 
nothing, like a waking dream ; forgets the word while speaking ; 
confusion of the head ; loss of consciousness ; delirium ; great 
weakness, weariness and bruised soreness, which compels to lie 
down, and yet every position feels too hard ; unrefreshing sleep, 
with anxious dreams, talking, and loud blowing during expira- 
tions ; bleeding from the nose ; trembling of the lower lip ; dry 
tongue, with a brown streak in the middle ; putrid smell from 
the mouth ; distention of the abdomen ; involuntarj^ discharge of 
feces and urine ; pleuritic stitches at every inspiration ; great 
sinking of strength. 

Arsen., especially for weak or debilitated individuals, old age 
and children ; in slow, protracted cases, with mild delirium ; loss 
of consciousness ; great restlessness and anxiety, manifesting 
itself in constantly moving head and limbs, while the trunk lies 
still, on account of too great weakness; picking of the bed- 
clothes; sopor; face distorted, sunken, anxious, hippocratic; 
lower jaw hanging down ; cheeks burning hot, with circumscribed 
redness ; eyes staring, glistening or sunken, dull and watery, or 
closed with sticky matter ; hardness of hearing ; lips dry and 
cracked; lips, gums and teeth covered with brown or black 
slime ; tongue red and dry, cracked ; stiff, like a piece of wood ; 
black tongue ; speech unintelligible, lisping, stammering, as 
though the tongue were too heavy; excessive thirst, but little 
drinking at a time; the fluid rolls audibly down into the 
stomach; vomiting and retching; burning in stomach and 
bowels, sensitive to pressure ; meteoristic distention of the abdo- 
men ; constipation or looseness of the bowels ; brownish or 
watery, bloody, foul, involuntary discharges; involuntary dis- 
charge of urine or retention of urine. Voice weak and trembling, 
or hoarse, coarse or crowing; breathing short and anxious, 
oppressed, rattling; dry cough; fetid breath. On chest and 
abdomen roseola-spots ; white miliary eruption, even petechia? ; 
decubitus ; excessive prostration and rapid emaciation ; pungent, 
hot, dry skin, like parchment; cold, clammy perspiration, pulse 
frequent, small, trembling, intermittent. A cadaverous smell 
scents the whole atmosphere. All symptoms worse about and 
soon after midnight or noon. 

Arum triph., lips and corners of mouth sore and cracked ; ex- 
cessive salivation; saliva acrid; breath very fetid; picking the 
ends of the fingers with the nails ; picking the lips until they 



TYPHOID FEVER. 985 

bleed ; boring with the ringers in the nose ; great restlessness, 
tossing over the bed, wants to escape while perfectly unconscious 
of what he is doing, or what is said to him; urine generally 
suppressed. (Lippe.) 

Baptis., " she cannot go to sleep, because she cannot get herself, 
together. Her head feels as though scattered about, and she 
tosses about the bed to get the pieces together." (Dr. Bell, of 
Augusta, Maine.) Dull, stupefying headache, confusion of ideas; 
delirious stupor ; heavy sleep, can scarcely be aroused long enough 
to answer a question, falling asleep in the middle of the sentence; 
dark red face, with a besotted expression ; injected eyes ; coated 
tongue, brown and dry, particularly in the centre, or dry and 
red ; sordes on the teeth ; fetid breath ; fetid sweat ; fetid dis- 
charges from the bowels; fetid urine; great debility and nervous 
prostration; ulcerations; chilliness all day ; heat at night; chilli- 
ness, with soreness of the whole body. Sensation as though there 
were a second self beside the patient in bed. 

Bellad., during the early stage, especially of tumultuous cases, 
when there is great congestion to the brain, with great drowsi- 
ness, and an inability to go to sleep, and frequent starting dur- 
ing sleep ; violent delirium, with attempts to run away, to strike, 
bite, or spit at his attendants; sparkling, staring eyes; throbbing 
of the carotid and temporal arteries, and also in the forehead ; 
deafness ; burning heat and redness of the face; distortions of the 
mouth ; dryness of nose, mouth, and throat ; tongue with red 
margin and white centre; trembling and heaviness of the 
tongue, with stammering as if drunk ; sore throat and dry cough 
from bronchial irritation. 

Bryon., in any stage when there is delirium, especially at night, 
about the affairs of the previous day or business matters; visions, 
especially when shutting the eyes; irritableness ; peevishness; 
easily offended; hasty speech; headache; dull, pressive, or stitch- 
ing, tearing pains, worse from motion and opening the eyes; eyes 
dull, watery ; hardness of hearing ; dryness of nose ; lips dry, 
brown, cracked ; tongue coated thick, white, or yellowish, later 
brown and dry; dry feeling in the mouth, without any thirst or 
else great thirst, with drinking large quantities at a time ; bitter 
taste in the mouth ; nausea ; retching ; great soreness in the pit 
of the stomach to touch or motion; bowels constipated; hard 
cough, with stitching pain in the chest and region of the liver ; 
bronchitis ; great lassitude and weakness ; wants to lie quiet ; 



pain in all the limbs when moving ; restless sleep, with groaning 
and moaning, and frequent movements of the mouth, like chew- 
ing ; eruption of white, miliary rash, with anxiety in the region 
of the heart; sighing, groaning and moaning, and a peculiar 
sour smell of the body, with or without sweat. 

Calc. carb., according to Goullon, during the aggravations, which 
precede the outbreak of the miliary rash, about the fourteenth 
day of the disease: palpitation of the heart, tremulous pulse, 
anxiet} r , restlessness, redness of the face, delirium, jerkings, espe- 
cialty in children ; short, hacking cough ; excessive diarrhoea. 
Besides this, it may be indicated at the very onset, and then cut 
off all further progress in persons inclined to grow fat; after 
great anxiety and worriment of mind ; utter sleeplessness from 
overactivity of the mind; it is the same disagreeable idea which 
always rouses the patient as often as he falls into a liglrf slumber; 
constant tickling under the middle of the sternum, causing a 
hacking cough, worse from talking or moving; during coughing, 
painful shocks in the head; the brain feels hot and burning. 
(Lippe.) 

Camphora, in extreme cases like Carb. veg., only that the sym- 
toms set in much more rapidly. Greatest weakness ; cold sweat 
all over; quickly decreasing temperature, especially of the ex- 
tremities ; small, very frequent, scarcely perceptible pulse ; great 
nervous restlessness of body and limbs ; collapse in face ; cold, 
pointed nose and mouth ; automatic motions of the muscles ; 
delirium ; syncope ; snatches of sleep ; great thirst, with red, dry 
tongue ; frequent involuntary stools, after much rolling and rum- 
bling in the bowels. (Trinks.) 

Canthar., may be indicated by its characteristic urinary symp- 
toms. 

Carb. veg., often at the brink of death a saviour, in those states 
of collapse, dissolution of blood, and paralytic conditions, which 
seem rapidly to invade the whole organism. All this is indicated 
by stupor, out of which the patient can scarcely be roused for 
moments ; the eyes are dull, without lustre, and the pupils with- 
out reaction against light ; the hearing is gone ; the face is pale, 
sunken, hippocratic, cold; there are hemorrhages from mouth 
and nose; the tongue is sometimes moist and sticky: other times 
parched and cracked, heavy, scarcely movable, bluish or pale; 
the pit of the stomach is bloated ; the abdomen meteoristie, with 
loud rumbling and gurgling of wind in the intestines ; there is 



TYPHOID FEVER. 987 

colliquative diarrhoea, brownish, grayish, or bloody, of a cadaver- 
ous smell, and involuntary. The cough has ceased, and the col- 
lecting secretions cause loud, rattling breathing, a sign of be- 
ginning paralysis of the lungs; the circulation is without energy; 
the blood stagnates in the capillaries, and causes cyanotic blue- 
ness of face, lips, and tongue ; ecchymotic spots here and there ; 
decubitus ; the pulse is extremely weak, frequent, small, scarcely 
perceptible ; face and extremities grow cold and become covered 
with cold perspiration — all signs of beginning paralysis of the 
heart ; in short, the patient offers a picture of complete torpor of 
all vital functions, thus differing entirely from that of Arsenicum, 
which is always more or less associated with erethism of the 
system. 

China, especially where there is painless diarrhoea, bloatedness 
of the abdomen, hsemorrhages, and slowly progressing convales- 
cence after such weakening influences. 

Coccul., in such cases which are mainly characterized by a de- 
primation of the nervous system, showing little or no disturb- 
ance in the vegetative sphere of the system, except enlargement 
of the spleen. There is a slowness of comprehension ; he don't 
find the right expressions for his ideas ; what has passed he can- 
not remember; he talks muttering, mumbling; it costs him great 
effort to speak the words plainly; and then again for a short 
while he is very irritable, cannot endure either noise or contra- 
diction, and speaks hastily. Most of the time, however, he sits 
in silence or feels an unconquerable inclination to sleep ; his eye- 
lids are heavy, fall shut, as if paralyzed ; the drowsiness may in- 
crease to coma. There is dizziness in the head, especially when 
rising up in bed, with nausea, compelling to lie down again ; 
ringing in the ears; heat in the head and chilliness in the re- 
maining body; pappy taste in the mouth; belching; nausea; 
distention and rumbling in the abdomen ; great general weak- 
ness and weariness ; great heaviness in the feet ; attacks of trem- 
bling and jerking of the eyelids, muscles of the face and limbs, 
and fits of fainting from bodily movement, with spasmodic dis- 
tortion of the facial muscles. Especially indicated after mental 
and bodily overexertion. 

Colonic, according to Wells, great weakness, as if after exertion. 
If the patient be raised up the head falls constantly backwards, 
and the mouth opens to the widest extent. Sudden sinking of 
the forces, so that in ten hours he can hardly speak or walk ; ca- 



988 FEVER. 

daverous aspect and extreme prostration ; emaciation ; lying on 
the back; comatose; eyes half open; respiration audible and ac- 
celerated ; hands and feet cold ; trunk hot and extremities cold ; 
skin dry ; sweating ; suppressed, cutaneous transpiration ; fore- 
head covered with cold sweat ; pulse small and contracted, quick, 
and hardly perceptible, small and frequent, quick and thready ; 
pulseless ; delirium, with cephalalgia; intellect beclouded, though 
he gives correct answers to questions ; unless questioned he says 
nothing of his condition, which does not seem to him danger- 
ous; perception entirely lost; he is unconscious; eyes hollow, 
staring and sunken ; pupils much dilated and little sensitive to 
light, or immovable, and but slightly dilated; nostrils dry and 
black; face sunken and hippocratic ; risussardonicus; lips, teeth, 
and tongue covered with a thick, brown coating ; lips cracked; 
face covered with perspiration ; grinding of teeth; tongue pro- 
truded with difficulty; tongue bright red; tongue heavy, stiff 
and numb; loss of speech ; inextinguishable thirst; epigastrium 
and stomach extremely sensitive to pressure ; abdomen distended, 
tense and hard ; surface of the abdomen hotter than the rest of 
the body ; tympanites with pain in the back ; watery diarrhoea ; 
the stools are passed insensibly ; stools fluid, offensive, with white 
flakes; involuntary stools; numerous, liquid, dark, offensive 
stools, with severe pain; secretion of urine suppressed; urine co- 
pious; involuntary urination; respiration irregular and inter- 
mittent. 

Cuprum, according to Baehr, in typhus without high fever, but 
with excessive weakness, which increases rapidly under the signs 
of dissolution of blood (nosebleed and petechia?), until under 
general paralytic symptoms death ensues. 

Fluor, ac, recommended by Hering when there is decubitus. 

Gelsem., stage of invasion with sense of extreme prostration; 
trembling from weakness; muscles refuse to obey the will; pulse 
slow, but greatly accelerated by lifting or turning the patient; 
severe pains in head, back and limbs ; chilliness, cold hands and 
feet; crimson flush of face; thick, brown, coated tongue; occa- 
sional moisture here and there; sleeps frequently half waking 
and talking incoherently ; head feels " big as a bushel ;" vertigo ; 
blind spells ; epistaxis ; iliac tenderness. (J. C. Morgan.) 

Ginseng, loud gurgling noise in the ileo-caecal tract, dry tongue, 
heat, delirium on going to sleep. (Liedbeck.) 

Hamam., haemorrhage from the bowels of fluid, dark, fetid 
blood; great soreness of the abdomen. 



TYPHOID FEVER. V8\j 

Helleb. nig., facies quatrata ; stupid expression, though the face is 
not collapsed ; vacant look of the eyes with dilated pupils ; con- 
stant somnolence, out of which the patient may be roused, but 
does not gain full consciousness; he stares at the physician, is 
slow in comprehending and answering his questions; all percep- 
tions by the senses grow only slowty or not at all conscious. The 
patient utters no desire; when left alone sinks in slumber; he 
lies upon his back with limbs drawn up; sliding down in bed. 
Mucous membranes but little or not at all affected ; abdomen not 
bloated, unpainful; no diarrhoea; sometimes unconscious dis- 
charge of urine; slow action of the heart; pulse only 80 per min- 
ute; respiration slow; temperature of skin nearly normal; no 
miliary eruption ; no sign of putrid dissolution of the blood ; loss 
of flesh trifling; only the brain seems to be the invaded part of 
the body. (Trinks.) 

Hydr. ac, when the drink which 'is swallowed rolls audibly 
down the throat, as though it were poured into an empty barrel. 
(Heynel.) 

Hyosc, entire loss of consciousness, and of the functions of the 
organs of the senses; does not recognize relatives or friends; illu- 
sions of the imagination and senses. Delirium which is con- 
tinued while awake, and which sees persons who are not and 
have not been present. Indistinct and muttering loquacity; 
muttering with picking of the bed-clothes; inability to think, 
the thoughts cannot be directed or controlled ; constant staring 
at surrounding objects, with apparent entire self-forgetful ness ; or 
else great agitation; restlessness; jumping out of bed; attempts 
to run away, etc. Eyes red and sparkling, staring, rolling about 
in their orbits; squinting; deafness; distorted face, stupid ex- 
pression ; tongue red or brown, dry and cracked ; paralyzed ; loss 
of speech, or indistinct speech; cadaverous smell from the mouth; 
involuntary or unnoticed stools in bed; suppressed secretion or 
retention of urine; involuntary discharge of urine, leaving streaks 
of red sand on the sheet. Paralysis of sphincter ani and vesicas. 
Convulsive motions; grating of teeth; jerkings; subsultus ten- 
dinum; trembling; sleeplessness, or constant sleep with mutter- 
ing; coma vigil. Roseola spots on chest and abdomen; cold 
extremities. 

Ignat, great impatience and despair about pains and bad feel- 
ings, which he cannot describe; gets easily frightened, and feels 
as though he were swung to-and-fro in a cradle or in a swing. 



990 FEVER. 

Attacks of yawning, stretching, followed by pain in the front of 
the head, which does not allow opening the eyes ; choking sensa- 
tion from the stomach up into the throat, with oppression in the 
chest, better from belching; palpitation of the heart; sinking, 
weak feeling in the pit of the stomach ; convulsive motions of the 
limbs; jerking of the tendons. Sleeplessness on account of vari- 
ous visions as soon as he falls in a doze; troublesome dreams. 

Kali carb., intermitting pulse, vomiting, headache, nervous, 
easily frightened, pale, sickly complexion. (Goullon, Jr.) 

Kreosot, typhoid haemorrhages, with fetid stools, followed by 
great prostration. (Trinks.) 

Laches., fever worse in the afternoon ; sweat without alleviation ; 
sleep with following aggravation of all the symptoms; loss of con- 
sciousness ; muttering ; stupor ; sunken countenance ; dropping 
of lower jaw; dry, red or black tongue, cracked on the tip and 
bleeding; in the attempt of protruding it, it trembles; or the tip 
remains under the lower teeth, and does not come out; dry lips, 
cracked and bleeding; stools very offensive, whether formed or 
loose; haemorrhage from bowels, with flakes of decomposed blood, 
having the form and appearance of charred straw, in longer or 
shorter pieces, together with portions more or less ground up ; 
sore throat, with deafness ; nasal, indistinct speech ; dyspnoea ; 
cough, with slimy, bloody expectoration ; after sleeping a short 
time, terribly restless, tossing about, and throwing the bed-covers 
off. 

Lauroc., clonic spasms of the upper and lower extremities, with 
paralytic weakness of the limbs; no loss of consciousness. (Trinks.) 

Lycop., sopor; delirium; uses wrong words for correct ideas, 
which he intends to express; fear to be left alone; restless sleep, 
with outcries and loud laughing; when awaking, exceedingly 
cross, irritable, scolding, screaming, behaving disagreeably: vio- 
lent jerkings of the limbs, shaking the whole body, awake or 
asleep ; subsultus tendinum ; catching at flocks ; sunken face, 
yellowish, or with circumscribed redness in the afternoon; tongue 
red and dry; sometimes it is spasmodically thrust to-and-fro be- 
tween the teeth; lower jaw sunken; bowels much distended, with 
rumbling and constipation; urine leaves, if voided in bed, a red, 
sandy stain ; cold hands and cold feet; one foot hot and the other 
cold ; wants to be uncovered during beat. 

Mercur. may be indicated at the beginning of the disease, when 
there is: swollen and bleeding gums; fetor from the mouth : pain 






TYPHOID FEVER. 991 

in the liver; yellow-green stools ; dark urine; bronchitis; icteroid 
color of the skin. " Obtuseness of mental operations, with great 
inclination to sleep ; heaviness and muddledness of the head ; 
thick and dirty whitish coating of tongue; insipid, pappy, slimy, 
foul taste, with desire for refreshing things; thirst; painful sensi- 
tiveness of prsecordial, hepatic, umbilical and ileo-csecal region; 
bilious, slimy or watery diarrhoea, which, however, may be absent 
altogether; prostration ; sometimes copious, debilitating perspi- 
ration ; pale and sunken face and eyes ; also dirty yellowish color 
of the face." (Trinks.) 

Moschus, in cases of impending paralysis of the lungs, where 
the cough ceases and the collected mucus cannot be expectorated ; 
where respiration and pulsation of the heart grow weaker and 
weaker; where in swallowing, the fluid rolls audibly down the 
throat, and stool and urine pass off involuntarily. 

Mur. ac, febris stupida; constant sliding down in bed, with 
groaning and moaning in sleep, and muttering and unconscious- 
ness while awake; excessive dryness of mouth and tongue; the 
tongue is heavy, paralyzed ; the patient cannot move it at will, 
even if conscious; the pulse intermits every third beat; profuse 
discharge of watery urine; watery diarrhoea; stools and urine 
involuntary. " Febris nervosa versatilis after Bryon., if the dis- 
ease still grows in intensity. Continuous delirium, hindering 
sleep and rest; the patient is all the time occupied with things 
past and present; he forgets time, place, and all he has said. 
Vivid hallucinations; the eyes shun the light; the ears are sensi- 
tive to slightest noises, and hear sounds — the falling of rain, or 
music — which do not exist; smell and taste very acute. The 
eyes glisten; the pupils are contracted; the cheeks reddened; nose, 
lips and tongue are dry; the tongue is not, or only slightly coated ; 
great thirst; little or no affection of the mucous membrane of the 
intestines; discharges from the bowels none, or but seldom; urine 
clear, of acid reaction ; pulse very frequent, irritated, without 
energy, 110 to 130 ; respiration accelerated ; skin mostly dry, hot. 
Great desire to sleep, without ability to go to sleep ; muscular 
power not very much decreased; slight feeling of weakness and 
weariness." (Trinks.) 

Nitr. ac, in cases of typhoid hsemorrhages ; great sensitiveness 
of the abdomen; green, slimy, acrid diarrhoea; tenesmus; white, 
coated tongue, with sore spots; inflammatory affection of the 
lungs, with rattling cough and breathing; brownish, bloody ex- 
pectoration and irregular pulse; after calomel. 



992 FEVER. 

Nuphar, liquid, yellow, fetid stools most frequent between four 
and seven in the morning. 

Nux mosch., profound coma ; lying silent, immovable ; insensi- 
ble; difficult comprehension; slowness of ideas; dwells long on 
her answer, or does not answer at all ; very deaf; putrid collo- 
quative diarrhoea; rolling, rumbling and gurgling in bowels; 
dreamy state, with drowsiness and falling of eyelids; dryness of 
mouth, tongue and throat, with fulness of stomach and loss of ap- 
petite; in the evening the dryness is so great that the tongue 
sticks to the roof of the mouth, yet there is no thirst. (Hering, 
confirmed by Nash.) 

Nux vom., " in the early stage, if there be chilliness on slightest 
movement; dryness of the front of the mouth and tip of the 
tongue; intolerance of impressions on the external senses, all of 
which seem much exaggerated ; great sensitiveness to the open 
air; thirst, with aversion to water; strong desire to lie down, and 
considerable relief on doing so." (Wells.) 

Opium, febris nervosa stupida; the stupor is complete; he can- 
not be roused or only with great difficulty ; lies speechless, with 
open eyes and stiff limbs; delirium, mild or furibund, with loud 
talking, laughing or singing; attempts to escape; congestion to 
the head; face dark red and bloated; respiration slow, deep- 
drawn and sighing, stertorous, rattling ; constipation or offensive 
watery diarrhoea ; involuntary stools; retention of urine. 

Phosphor., pneumo-typhus ; violent bronchitis and even hepati- 
zation; hard, dry cough with tightness in the chest; or loose, 
rattling cough, with tough, transparent, or thick, yellowish, or 
reddish expectoration ; cough worse from evening until midnight ; 
vomiting of watery, bilious, and slimy masses with great pain: 
frequent, unpainful diarrhoea, with meteorism and loud rum- 
bling; the discbarges are watery, greenish, grayish, or black from 
decomposed blood; great weakness after each discharge: numer- 
ous roseola-spots, ecchymosis, and miliary eruption on the trunk ; 
great heat of the trunk, with cold perspiration on head and ex- 
tremities. " Rapid sinking of strength ; very quick, small, thread- 
like pulse; stupor; unconsciousness; sopor and stupefaction; 
delirium and flaccilegium ; hardness of hearing; dull, half-shut 
eyes; hippocratic face; lying on back; dry, immovable tongue, 
covered with black crusts; very sensitive abdomen, painful to 
touch ; rolling and rumbling in abdomen during and after drink- 
ing; rattling in windpipe; impending paralysis of brain and 
collapse ; burning pain in the brain." (Trinks.) 



TYPHOID FEVER. 993 

Phosph. ac, complete apathy and indifference ; don't want to 
talk; answers slowly and reluctantly, or short, incorrectly; stupid 
sleep from which he may be roused, when he answers correctly, 
but soon falls asleep again ; stupor ; stupid and indifferent ex- 
pression of the face ; bleeding from the nose ; meteoristic disten- 
sion of the abdomen, with a great deal of rumbling and gurgling, 
and unpainful, watery, grayish diarrhoea, also involuntary stools ; 
great debility ; relaxed pale skin ; ecchymosis , bluish-red spots 
on the parts which the patient lies upon ; decubitus ; temperature 
of the body not high ; constant, sticky, or profuse sweat ; pulse 
weak and small, frequent, and intermitting. " Dryness of the 
mouth and throat; gray-whitish coating of the tongue; the 
patient slumbers even in daytime, with murmuring delirium ; 
the eyes are dim, sleepy ; the skin remains dry or clammy ; a 
miliary rash appears first about the neck, then upon the back, 
then on the chest, etc., at last upon the feet." (Trinks.) 

Psorin., retarded convalescence from profuse perspiration ; pa- 
tient hopeless and despairing of recovery; extreme prostration. 
(Hering.) 

Pulsai, at the early stage where external heat is intolerable, 
causing a sense of heat with distress; uncovering, however; is 
followed immediately by a chill; or there is heat only of one 
side, or heat of one side with coldness of the other, or sweat of 
one side ; there may be great drowsiness ; delirium ; frightful 
visions ; dry tongue, as if burnt, and yet no thirst ; rumbling in 
the bowels and diarrhoea, with pinching pain, worse at night ; 
pulsating in the epigastrium. 

Rhus tox., mental operations are slow and difficult ; he answers 
correctly but slowly, sometimes hasty ; delirium ; talks much to 
himself, or talks incoherently, without any seeming connection of 
ideas; headache; worse from opening and moving the eyes; 
bleeding from, the nose, especially after midnight ; the lips are 
dry and covered with brown crusts ; the tongue is red at the tip, 
in the shape of a triangle ; the bowels are loose, worse at night ; 
involuntary alvine discharges during sleep. There is often severe 
cough, with tough, bloody expectoration ; bronchitis ; pneumonic 
infiltration of the lower lobes of the lungs; severe rheumatic 
pains in the limbs, worse in rest ; somewhat ameliorated by mov- 
ing and changing position ; constant restlessness ; tossing about ; 
restless sleep, with frightful dreams, and frequent waking, and 
never that state of quiet, profound coma ; dry heat or sweat, dur- 



994 FEVER. 

ing which the patient desires to be covered ; roseola spots ; mili- 
ary eruption; great exhaustion. 

Secale, large purple spots on the body, particularly on the feet ; 
body cold, especially hands and feet, and would not be covered ; 
cold perspiration, mostly on face and forehead ; copious vomiting 
of thick, black bile, mixed with mucus. (Lippe.) 

Silic, sometimes in the very worst cases, with excessive debility, 
profuse perspiration, and a strong desire to be magnetized; 
magnetizing relieves the great weakness, and Silicea promotes 
the forming of abscesses, boils, etc., thus throwing the poison to 
the surface, and securing a gradual though slow recovery. 

Stramon., loss of consciousness ; imbecility ; stupefaction of the 
senses; delirium; hallucinations; singing; laughing; whistling; 
screaming ; constant, involuntary, odd motions of the limbs and 
body ; spasmodic distortions of the face ; staring look ; wrinkled 
skin on forehead ; loss of sight, hearing and speech ; all objects 
appear oblique to him ; inner mouth feels raw and sore, or is 
ulcerated ; red rash upon the chest ; blackish diarrhoea every 
hour; stools smell like carrion; suppressed secretion of urine; 
retention of urine ; copious, involuntary discharge of urine. Fe- 
bri's nervosa versatilis. 

Sulphur, when in psoric individuals the well-selected remedy 
has no or only a superficial effect ; besides, if there be sleepless 
nights ; slow comprehension when being asked ; heat and fulness 
in the head; chronic sore and inflamed eyelids; great dryness 
of the ears ; pale, sickly aspect ; bright, red lips ; undefined red- 
ness on the tip of the tongue ; bleeding from the nose, teeth and 
gums ; offensive smell from the mouth ; diarrhoea, worse early in 
the morning, unpainful or with tenesmus; great prostration 
after stool; offensive urine; catarrh and inflammation of the 
lungs, especially during commencement of infiltration, recogniz- 
able by the crepitation sound. 

Tarax., during rest intolerable tearing pains onty in the lower 
extremities (Rhus tox. has such pains in all the limbs) ; constant 
muttering to himself, similar to that of Hyosc. ; violent, tearing 
pain in the occiput ; great chilliness after taking anything to eat 
or drink, (v. Boenninghausen.) Map-tongue. 

Tart, emet, in pneumo-typhus, with great rattling in the chest, 
dyspnoea, etc. ; symptoms of oedema pulmonis. 

Tereb., bloody urine. 

Veratr., during cholera epidemics; great prostration; cold 



TYPHOID FEVER. 995 

sweating; coma; vomiting and watery diarrhoea; bluish face; 
pointed nose; wrinkled skin. 

Ver. vir., constant talking and muttering unintelligibly, with 
open eyes; squinting; ocular conjunctiva injected, secretion of 
yellow mucus at inner canthus; nightly agglutination; face pale, 
with cold sweat; boring occiput into pillow, jerking head back- 
ward, sometimes forward. Pupils dilated; dropping of lower 
jaw; corner of mouth drawn down on left side; champing teeth; 
tongue coated white; red streak down the centre; beating of 
heart when turning over in bed, shaking left side of thorax; 
pulse irregular; urine dark and turbid, fetid, involuntary; great 
restlessness ; constant moving, thrusting out one leg, then draw- 
ing it up ; position on back with thighs flexed on pelvis ; car- 
phologia; picking at bed-clothes; subsultus tendinum, like gal- 
vanic shocks; twitching of facial muscles. (G. W. Sherbino.) 

Zincum, staring eyes; delirium with attempts to get out of bed ; 
complete unconsciousness ; lying on the back and sliding down 
in bed; grasping at flocks; subsultus tendinum ; constant trem- 
bling of the hands and coldness of the extremities; relaxation of the 
muscles of the face; hippocratic face; pale, waxy complexion of 
the face; decubitus on the sacrum and trochanter; frequent, in- 
voluntary discharges from the bowels; frequent, small, intermit- 
ting, scarcely perceptible pulse; impending paralysis of the brain. 

GENERAL HINTS. — In predominant cerebral symptoms, com- 
pare: Apis, Bellad., Bryon., Cuprum, Hyosc, Laches., Opium, 
Stramon., Zincum. 

In predominant abdominal affections: Apis, Arsen., Bryon., 
Carb. veg., China, Colchic, Ginseng, Mercur., Nux vom., Phosph. 
ac, Rhus tox., Secale, Sulphur, Veratr. 

In pneumo-typhus : Apis, Bellad., Bryon., Mercur., Phosphor., 
Pulsat., Rhus tox., Sulphur, Tart. emet. 

In febris nervosa stupida: Arnica, Arsen., Carb. veg., Coccul., 
Hyosc, Laches., Mur. ac, Phosph. ac, Rhus tox., Secale. 

During convalescence, when there is too great hunger : Pulsat. 

Diarrhoea, with cutting in the bowels after sour things: Ipec. 

Overexertion of the body : Rhus tox. 

Fright: Ignat. 

Chagrin: Nux vom. 

Loss of memory : Anac 

Complaints, which go from above downwards: Selen. 



When commencing below and spreading upwards : Guaco. 
Protracted convalescence: Psorin. 

Relapsing Fever, Typhus Eecurrens. 

This fever has been described as early as 1741 by Rutty, by 
Barker and Cheyne from 1816-21, still later by Griesinger, Wun- 
derlich and many others. Epidemics of the same have prevailed 
at different periods in Ireland, Scotland, England, Germany, 
Africa and North America. Some of these epidemics were inter- 
mingled with other forms of typhus, were often widely spread, 
and at times preceded or followed by epidemics of intermittent 
fevers. But also single cases have now and then been observed, 
and in London the fever seems to have become stationary. 

If yellow fever is essentially a fever of one paroxysm, the re- 
lapsing fever consists in the majority of cases of two (seldom 
more) paroxysms, which are separated by an interval of com- 
parative health, lasting from four to seven or to fourteen days. 
This long remission made the second paroxysm appear like a 
relapse of the disease, wherefore the name " relapsing fever" was 
applied to it by English physicians. 

It is as contagious as typhus enanthematicus, and because Ober- 
rneier discovered protomycetes in the blood of patients with re- 
lapsing fever, some consider these spinal filaments, which, ac- 
cording to Lebert's, Weigert's and Buchwald's observations, are 
never absent during the periods of invasion and relapse, as the 
doers of all the mischief, by which infection is brought about 
through the media of contact, air or water. 

The Symptoms of typhus recurrens are the following. Mostly 
in the morning, or in the middle of the day, less frequently in 
the evening or night, the patient is, in many cases without any 
premonitory signs, suddenly attacked with high fever, which may 
or may not be preceded by chilliness or a severe chill. The tem- 
perature rises rapidly to 102.2° F. in the morning, and to 104° F. 
in the evening, in a few days to 105.S in the morning, and to 
107.6° F. in the evening. The pulse amounts to 108 or 112 in 
the morning, and to 120 and over in the evening. In spite of 
this high temperature the skin is usually moist. At the same 
time the patient experiences severe headache, and severe pain in 
the limbs, joints and loins ; in fact, all the muscles of the body 
are the seat of severe pain, especially the calves ; there is dizzi- 



RELAPSING FEVER, TYPHUS RECURRENS. 007 

ness, congestion towards the face, sensitiveness to light and noise, 
restlessness and sleeplessness at night, loss of appetite, bad taste 
in the mouth, thickly coated tongue, later dry, nausea, vomiting, 
and intestinal catarrh. On the second day already the patient com- 
plains of heaviness in the upper part of the abdomen, and of pain 
in the left hypochondrium ; the spleen begins to swell and rapidly 
increases in size, and so does the liver. There appears at times 
a miliary rash, and herpes facialis, which latter are never observed 
in typhus fever. Bleeding at the nose is rare, and delirium is 
not a frequent symptom. But the loss of strength is rapid, and 
emaciation goes on progressively. Thus the disease increases all 
the while for five, six or seven days, producing sometimes at the 
very height a deadly paleness of the face and lips, when all at 
once, with the appearance of a profuse sweat, a remission sets in, 
that is truly astonishing. The pulse sinks within a few hours, 
in many cases within two or three days, to 88, 60 or still lower 
per minute, and the temperature decreases some five, six, even 
seven degrees in the same time. With this remission of the fever, 
also all the other symptoms above described cease, and the pa- 
tient, although still very weak, feels comparatively well. In 
some cases, however, where the remission does not take place so 
suddenly or so completely, the patient experiences even during 
this apyrexia severe pains in the limbs, and now and then some 
febrile aggravations. Yet, nevertheless, the whole process looks 
to any one unacquainted with the character of the disease entirely 
as a state of convalescence. This interval of freedom from fever 
lasts for about four, seven or fourteen days, when the relapse be- 
gins unexpectedly, sometimes in the forenoon, or afternoon, but 
most generally at night. This new paroxysm is quite similar to 
the first. After a chill or mere chilliness, or neither, the tem- 
perature rapidly rises again to 102.4° F. and over, and the pulse 
to a frequency of from 112 to 120 or more. With this rise, all 
the other symptoms set in again : feeling of great malaise, vomit- 
ing, violent pain in head and limbs, swelling of the spleen, etc. 
This second attack is usually somewhat milder than the first, 
lasts in favorable eases from two to four days, when again a sud- 
den cessation of the fever and of all the other symptoms takes 
place, which leads either to complete convalescence or is followed, 
though only in exceptional cases, after the lapse of several days 
by a third, or even a fourth, much milder attack. Recovery, 
even in favorable cases, is generally slow ; it takes a great while 



DOS FEVER. 

before the patient recuperates the lost strength, and he experi- 
ences often for a long time severe pain in the limbs, while in 
other cases it is followed by various ailments. 

Not all cases, however, take so favorable a course, especially if 
they take the form of a bilious typhoid, or typhus biliosus, which 
by some authors is considered as a distinct disease. In severe 
cases the second paroxysm does not terminate in sweat, may be 
not even the first one, but the symptoms keep on increasing until 
they assume the character of the gravest form of typhus. There 
is great prostration, stupor, delirium, hardness of hearing, dry> 
brown tongue, involuntary discharges from the bowels, sometimes 
continual vomiting, jaundice, coma, convulsions, and death. In 
other cases death takes place unexpectedly during a short apy- 
rexia by a sudden collapse with, vomiting. In some epidemics 
the remission is very inconsiderable and the second paroxysm 
appears almost as a continuation of the first ; or there is indeed 
no remission at all, but a continuous fever lasting from three to 
four weeks. Or, instead of the first paroxysm being the strongest 
and longest, it happens that the second is by far the most severe. 
Often there has been found at the height of the paroxysm, when 
the sweat appeared, a sudden eruption of miliaria ; also, especi- 
ally when petechial typhus was prevalent at the same time, 
roseola eruptions and a spotted appearance of the skin. Quite 
unlike to other forms of typhus, febris recurrens frequently pro- 
duces herpes facialis. Icterus has frequently been seen in some 
epidemics, in others less frequently, and in still others not at all. 
The liver now and then shows a moderate swelling and some 
sensitiveness. Peculiar is the great hunger in some cases, which 
the patient experiences during the height of the disease, and in 
other cases the continual vomiting of grass-green fluid, or the 
copious bilious diarrhoea. Dysentery has been observed in a 
great many cases either as a complication or a sequela of the dis- 
ease. The second paroxysm is now and then attended with uri- 
nary difficulties, even cessation of the urinary secretion. 

There are also hemorrhages to be noticed, which may take 
place from the nose either at the commencement or at the end of 
the first paroxysm; or from the mouth, stomach, intestines, bladder, 
or beneath the epidermis as petechial effusions, in very severe 
cases which are generally complicated with a high degree of 
icterus. Decubitus, gangrene, parotitis, erysipelas are only occa- 
sional occurrences. An attack during pregnancy frequently 
causes abortus, which, however, has only seldom proved fatal- 



PLAGUE. 999 

As Sequelae have been mentioned : abscesses, furuncles, paro- 
titis, and laryngeal affections; ansemia; palpitation of the heart; 
pain in the limbs ; oedema ; hydrops and albuminuria ; tubercu- 
losis ; diabetes ; paraplegia ; loss of speech ; amaurosis ; mental 
derangements. 

Diagnosis. — The distinguishing feature of febris recurrens in 
the first week is the extreme high temperature of the body and great 
frequency of the pulse, which, however, show marked daily remis- 
sions in the morning, a temperature which cannot be explained 
in the total absence of any local affection. There is in short no 
corresponding relation between the intensity of the fever and the inten- 
sity of the attending symptoms. 

Abdominal typhus scarcely ever, except in the worst cases, at- 
tains in the first week such a height of temperature; scarcely ever 
takes such a rapid beginning ; and never shows such a rapid re- 
mission of fever. 

Petechial typhus shows mostly about the sixth day the roseola- 
exanthema and never such a sudden remission of fever about the 
end of the first week. 

The Prognosis differs essentially in different epidemics ; some 
are severer than others. It is stated that the mortality in febris 
recurrens amounts from three to four per cent., scarcely ever to 
six or eight. The fatal issue takes place mostly in the second, 
but frequently also at the height of the first paroxysm by a rapid 
collapse. Other patients die with uraemic symptoms, sudden 
convulsions, coma and collapse, and still others lie for several 
days in a profuse perspiration, which is followed by collapse. 

THERAPEUTIC HINTS.— There are mentioned: Arg. nitr., Arsen., 
Bryon., China, Eupat. perf., Nux vom. Compare Typhoid and 
Intermittent Fever. 



The Plague. 

This disease has been raging epidemically at different periods 
in the Eastern countries. Europe has been free from it since 
1841. It is, according to Liebermeister, like typhoid fever, a 
contagious-miasmatic disease, that is, it is not transmitted directly 
from person to person, like typhus exanthematicus or small-pox, 
etc., but almost exclusively in an indirect manner through clothes 
and other effects. The contagiousness is greatly enhanced by 



1000 FEVER. 

deficient ventilation of the streets and houses, by the crowding 
together of many individuals into a small space, and by un- 
cleanliness. 

The stage of incubation is given at from two to seven days, but 
the capability of the plague poison to live outside of the human 
body seems under certain conditions to extend over several years. 

Its stage of invasion begins suddenly, with bodily and mental 
weakness, headache, dizziness, pale and flabby face, distorted 
features, languid eyes, awkward speech, staggering gait, without 
fever, exhibiting the picture of an intoxicated man. Sometimes 
it is attended with vomiting and diarrhoea, and lasts from a few 
hours to one or more days. 

The second stage is characterized by an intense fever, which is 
introduced by chilliness or by a well-marked chill; the pulse is 
very frequent and the respiration accelerated. The patient soon 
passes into a well-formed typhous condition, with wild or mild 
delirium, stupor and coma, dry, cracked tongue, sordes on teeth 
and lips, soot-colored crusts in nostrils, cardiac weakness, feeble, 
small, irregular pulse, sometimes cyanosis of the lips. This stage 
may continue for two or three days, when 

The third stage commences with the appearance of buboes, 
usually attended with a diminution of the fever, the breaking 
forth of a sticky, strongly smelling sweat, a lowering of the pulse 
and the returning of consciousness. The buboes occur oftenest 
in the inguinal regions, but also in the axillae or on the neck, 
but as a rule, only in one of these regions at one time. They are 
sometimes quite small; in other cases they attain the size of a 
hen's egg or even larger. Their suppuration is considered as 
favorable ; in other cases the tumors become resolved. 

Besides buboes there occur in some cases carbuncles, usually on 
the lower extremities, also on the buttock and on the back of the 
neck. Petechias, vibices, or extensive ecchymoses appear only in 
the severest cases shortly before death. 

"Convalescence begins generally between the sixth and tenth 
day, and is often protracted by continuous suppuration of the 
buboes. Among the Sequels should be enumerated parotitis, 
furuncle, abscesses of the skin and muscles, pneumonia, pro- 
tracted fever with continued typhous condition, dropsy, partial 
paralysis, mental disturbances, etc. Genuine relapses may also 
take place." (Liebermeister.) 

Death can occur during any stage of the disease. The mor- 



MEASLES, MORBILLI. 1001 

tality of plague is greater than that of any other epidemic disease. 
But the different epidemics vary greatly in this respect. 

THERAPEUTIC HINTS.— In the August number, 1879, of the 
North American Journal of Homoeopathy, page 63, Dr. Hering says: 
"Lorbacher proposes as the main remedies for the plague: 
Laches., Arsen., Carb. veg., Chin, sulph. and ars., Phosphor., Secale and 
Anthrac. "We may mention here our proving of Badiaga, which 
might be considered a remedy against the plague. What Laches, 
will do is uncertain. Still more uncertain is Arsen. Chin, ars., 
not being proved, we may leave aside altogether. Secale is 
another drug only known by poisonings. Anthrac. very likely 
will be of great importance in the plague. Kali phosph., proposed 
by Raue, we permit ourselves to mention as very promising. 
Stramon. has more similarity to the plague symptoms than Bel- 
lad.; and Silic. more than Hepar. Lohnine, a preparation of the 
pus of the plague, brought here by Dr. Theuille', has cured cases 
of the greatest importance; one with suppurating swellings along 
both sides of the neck, and cured them permanently." 



EXANTHEMATA. 
Measles, Morbilli. 

Measles are contagious, and more so during the stadium pro- 
dromorum et eruptionis than at a later period. The nature of 
the poison is entirely unknown. Only this much is certain, that 
it regenerates itself in the infected person, impregnates the sur- 
rounding atmosphere, and that it may be carried from there to 
other quarters. Measles prevail therefore mostly as epidemics, in 
preference, it seems, during those months which favor catarrhal 
affections. As a general rule they attack a person only once in 
life, and children more than grown persons, although there are 
many exceptions. Also relapses occur sometimes after a few days 
or a few weeks. The time of incubation varies from one to two 
weeks. 

The eruption of measles consists of numerous, roundish, lentil- 
sized red spots, which are a little raised above the level of the 
surrounding skin and generally contain in their centre a little 
papule. The closer they appear the more they coalesce, and in 
this way form irregular-shaped plaques, while on places where 



1002 EXANTHEMATA. 

they are scarce they stand isolated. Between these spots the skin 
retains its normal color; on the face, however, it is usually some- 
what cedematously swollen. Even in cases where they appear so 
abundantly as to coalesce (morbilli confluentes) they do not present 
an evenly diffused redness, but always a spotted appearance. 
There are cases in which the hyperemia of the skin results in 
an extravasation of blood, causing the eruption to assume a dark, 
blood-red appearance, and petechial spots to appear between the 
eruption ; this form is called morbilli petechiales or hxmorrhagici, 
or rubeolas nigrse. The measly redness disappears under the 
pressure of the finger and reappears again after removing the 
finger, from the middle towards the periphery, contrary to scarlet 
fever redness, which reappears from the periphery towards the 
centre. Measles are always more or less accompanied by ca- 
tarrhal affections of the eyes, nose, larynx and bronchial tubes, 
even by pneumonic symptoms. The blood is, like in other in- 
fectious diseases, poor in fibrin and of a dark color. 
The course and progress of measles is as follows : 
The first stage, or the stadium prodromorum, consists in a seem- 
ingly simple. cold in the head and chest. There is chilliness and 
feverishness, and the temperature increases rapidly to 102° or 
104° F., but lessens again considerably on the next day; there 
is headache, sensitiveness to light, watery eyes, watery dis- 
charge from the nose sneezing, nosebleed, hoarseness and cough, 
which latter sometimes assumes a croupy nature. Only in excep- 
tional cases these symptoms amount to any considerable severity, 
and may then be associated with vomiting, delirium and sopor; 
in the majority of cases, however, the little patients do not mind 
them, but run about. On inspection of the fauces we observe that 
about the third day of this premonitory stage the identical erup- 
tion of measles has already made its appearance in the form of 
single, lentil-sized red spots upon the roof of the mouth and the 
palatal mucous membrane, some twenty-four or twelve hours 
before there is any sign of an eruption on the external skin. 
This accounts at once for all the catarrhal symptoms, and for the 
fact that measles are already transmitted at this early stage from 
child to child by the mere breath. 

The second stage, the stadium crvptionis, begins on the fourth 
or fifth day and is marked by an exacerbation of the fever ; the 
temperature of the body rises again, averages during the height 
of the disease about 104°, and may, in severe cases, reach even 



MEASLES, MORBILLI. 1003 

105.8 F. During this time it happens occasionally that convul- 
sions set in. The eruption appears first on the face and spreads 
gradually downwards over the whole body. There is now a pecu- 
liar measle-smell, scenting the whole atmosphere of the patient. 
In anomalous cases the eruption appears at first on the arms ; in 
others it stays confined to single portions of the body, and in still 
others there is no eruption at all (morbilli sine exanthemata), al- 
though all the other symptoms and the previous exposure to the 
contagion leaves no doubt as to the nature of the disease. The 
stadium eruptionis generally is completed in twenty-four to 
thirty-six hours, although in some cases it lasts three, even four 
days, in which cases the first spots already disappear when the 
last come out. During this stage diarrhoea often sets in, and the 
catarrhal affection generally reaches its acme, but in malignant 
epidemics death may ensue in consequence of general paralysis 
and adynamia already at this early stage. In such cases the 
pulse grows weaker and weaker ; the cutaneous capillaries burst 
and cause hsemorrhages within the cutis; the prostration of 
strength is excessive and the patient sinks into a typhoid con- 
dition. 

The third stage, the stadium florescentise, is blended with the ' 
eruptive stage. In usual cases, already twenty-four hours after 
its full development, the redness commences to grow paler, and 
with it all the other symptoms, heat and catarrh, gradually grow 
milder. Such normal cases are termed morbilli vulgares, simplices 
or erethici. 

In other cases the measle-spots grow darker, assume a purple 
color, and remain visible upon the skin for five or six days. The 
dark coloring of the eruption is owing to the rupture of the cuta- 
neous capillaries, and for this reason the redness does not disap- 
pear under the pressure of the finger. The whole morbid process 
approaches that of other inflammatory processes. The heat rises 
above 101° F. ; there is throbbing of the carotid arteries, palpita- 
tion of the heart, and a full, strong pulse ; the catarrhal cough 
not unfrequently changes into a croupy cough, and there may 
exist a complication with lobular pneumonia, or the catarrhal 
affection extends upon the alimentary canal and causes vomiting 
and diarrhoea. This state of things may augment to complete 
prostration and collapse ; then the eruption disappears from the 
skin, and such a condition is not without danger. This form of 
measles has been termed morbilli inflammatorii, or synochales. 



1004 EXANTHEMATA. 

A still other form is that which has already been alluded to in 
the second stage. It is characterized by general adynamia and 
torpor. The eruption remains visible only a short time, is either 
pale-reddish or purple, and frequently interspersed with petechia. 
It is often combined with profuse bleeding from the nose ; the 
pulse is very frequent and scarcely perceptible, and the patient 
sinks into sopor and collapse. This form is called morbilli as- 
thenici, nervosi, torpidi, or septici. 

The fourth stage, the stadium desquamations, commences in 
simple cases usually about the eighth or ninth day of the disease. 
The measle-spots have at this time entirely disappeared, and in 
their places we observe a gradual loosening of the epidermis, 
which is thrown off in the form of fine scales. This process can 
best be observed on the face and hands, while on the parts cov- 
ered, the loosened skin is rubbed off before it is noticed. This 
stage is rarely interrupted by dangerous complications ; still, it 
may become complicated by croupous laryngitis or pneumonia. 
Noma or mortification of the labia pudenda is of very rare oc- 
currence. 

As Sequelae of measles are mentioned as quite prominent, 
chronic, catarrhal cough, and chronic pneumonia, which may 
end in consumption. Besides these, a number of scrofulous affec- 
tions, such as chronic inflammations of the eyes, otorrhcea, 
glandular swellings, and chronic inflammations of the periosteum 
and of the joints. It is but just to remark that under homoeo- 
pathic treatment sequelae are of very rare occurrence. 

THERAPEUTIC HINTS.— The bed-room should be kept of an 
equal temperature at about 65 or 66° F. It ought to be aired 
frequently with care. The light in the room should be modified 
according to the patient's own desire. If he wants to drink, he 
may have cold water, he may eat fruit provided his bowels are 
not disordered. When the fever, catarrhal irritation and desqua- 
mation have passed off, he should have a warm bath, and on the 
following day a cool wash all over, taking care that it be done 
quickly, and that the patient be well rubbed and dried by flannel 
afterwards. From this time he may be allowed to go into the 
fresh air, provided the weather allows it. 

Aeon, is the very remedy at the beginning, because it corre- 
sponds to all the symptoms of usual cases — full, quick pulse; dry, 
hot, burning skin; fever; restlessness; catarrhal irritation from 



MEASLES, MORBILLI. 1005 

the eyes down into the bronchial tubes ; nosebleed ; dry, hack- 
ing, or even croupy cough ; stitching pains in the chest ; restless 
sleep, with jerking and starting; grating of the teeth, moaning 
and groaning, or sleeplessness with great agitation and anxiety; 
pain in the stomach and bowels, with vomiting and diarrhoea. 

Ant. crud., pain in tbe ears; white, coated tongue; gastric de- 
rangements. 

Apis, confluent eruption and cedematous swelling of the skin; 
greatly inflamed eyes; croupy cough; violent cough, similar to 
whooping-cough; catarrh of the bowels, with diarrhoea; prostra- 
tion, muttering and delirium. 

Arsen., in adynamic cases. Persistent burning heat of the skin ; 
frequent, quick and small pulse ; great anxiety ; restlessness; pal- 
pitation of the heart; too early or sudden disappearance of the 
rash; pale, earthy color of the face; bloatedness of the face; 
thrush in the mouth and fauces ; constant craving for cold water, 
with but little drinking at a time; vomiting and diarrhoea; 
great sinking of strength; all worse about midnight. 

Bellad., m&y be indicated as often as Aeon, in the commence- 
ment, if there be heat with moisture of the skin, quick, but soft 
pulse ; constant drowsy sleep, or drowsiness with inability to go 
to sleep; congestion to the head; injected eyes; thick, white- 
coated tongue; sore throat, even diphtheritic; hollow, barking, 
croupy cough; jerkings of the limbs; convulsions. 

Bryon., by slowly forthcoming eruptions and inflammatory affec- 
tions of the chest; dry, painful cough, constipation, etc. 

Camphora, in those dangerous cases where the face grows pale 
and the skin cold, assuming a bluish, purple color, with utter 
prostration and spasmodic stiffness of the body. Also in differ- 
ent after-complaints, especially painful and difficult micturition. 

Carb. veg., persistent hoarseness after measles. 

Chamom., painful, watery diarrhoea, in consequence of taking 
cold. 

Coffea, nervous, restless agitation, preventing all sleep; short, 
dry, hacking cough. 

Cupr. ac, measles, bronchitis, delirium, wants to go home; ex- 
pectoration only during the night. (J. C. Morgan.) On falling 
asleep, begins to talk, scold, turn, twist and scream; on being 
aroused, was perfectly rational, tongue and mouth red. (J. F. 
Miller.) 

Drosera, cough, with drawing together of the epigastrium, simi- 



1006 EXANTHEMATA. 

lar to whooping-cough, also paroxysms of cough after measles, 
worse in afternoon and evening, even when attended with bloody 
and purulent expectoration. 

Euphras., streaming of hot, burning tears from the eyes, with 
great photophobia; profuse running from the nose, without burn- 
ing; cough only during the day. 

Gelsem., after Aconite, great deal of coryza; drowsy with fever 
heat, no thirst. When the eruption turns livid, with cerebral 
symptoms. 

Hepar, croupy cough, with rattling in the chest, but without 
expectoration ; worse in the morning. 

Ipec, tardily forthcoming eruption, with oppression of the chest ; 
tickling cough and vomiting. 

Kali bichr., flowing of water from the eyes, with burning when 
opening them ; pustules on the cornea ; stitches in the left ear 
extending into neck and head, with swelling of the glands; 
watery discharges from the nose, with great sensitiveness and 
ulceration of the nostrils; thirst, with dryness of mouth and 
tongue ; watery diarrhoea, followed by tenesmus ; loud, rattling 
cough, with stringy expectoration. 

Laches., livid eruption, countenance almost black, tongue coated 
dark brown, sordes on teeth, inability to protrude the tongue. 
(J. F. Miller.) 

Mercur., diarrhoea, with pain in the bowels and tenesmus ; moist 
barking cough, without expectoration ; the cough is almost con- 
vulsive and cannot be controlled, occurring in frequent par- 
oxysms, particularly from 9 A. M. till 5 or 6 P. M. (C. Wessel- 
hoeft.) 

Nux vom., after previous use of drugs ; nose stopped up ; cough 
dry in the evening and loose in the morning. 

Phosphor., in complication with bronchitis and pneumonic symp- 
toms; tightness across the chest, with a dry, tight cough; worse 
from evening until midnight ; unpainful diarrhoea. 

Pulsat, inflammation of the eyes and photophobia : thick, yel- 
low discharge from the nose; dryness of the mouth, without 
thirst ; nightly diarrhoea, after previous rumbling in the bowels ; 
rattling, loose cough, with expectoration of thick, yellow mucus ; 
increase of all the symptoms towards evening; chronic, loose 
cough after measles. 

Stramon., sometimes before the outbreak of the eruption, if there 
be frightful visions of rats, mice, etc., at which the patient is 



SCARLATINA. 1007 

startled and from which he tries to hide ; spasmodic affection of 
the oesophagus, hindering swallowing. 

Sulphur, either during the first stage, when the eruption makes 
a tardy progress, or for after-complaints, such as chronic coughs, 
originating in remnants of partial pneumonia ; chronic diarrhoea; 
hardness of hearing ; chronic discharge from the ears. 

Veratr., pale, livid color, and tardy appearance of the eruption ; 
haemorrhages without amelioration ; burning heat with alternate 
cold extremities ; very frequent, weak, intermitting pulse ; deli- 
rium; restlessness; drowsiness; apathy. 

Ver. vir., during febrile stage, especially if pulmonary conges- 
tion is impending ; red streak down the centre of tongue ; con- 
vulsions before eruption. 

Scarlatina. 

Scarlet fever is characterized by the following features : 
1. An eruption of the skin due to hyperaemia, with numerous 
and closely aggregated red points about the size of a pin's head, 
in normal cases equally distributed over the whole surface of the 
body. These scarlet points are either flat or slightly elevated, 
and as the hyperaemia increases, the vividly red points, originally 
isolated, gradually become confluent, and the exanthem assumes 
a uniform, intense redness, with turgescence of the skin, which 
appears stretched and glistening (Scarlatina laevigata). In other 
cases the eruption is but partial, or it may assume the shape of 
large roseola spots, from the size of a lentil to that of a bean, and 
of various shades of color, when it is called "Scarlatina variegata." 
Or the oedema of the skin is more considerable, and marked by a 
punctate injection in the form of small but numerous papules, 
which can be better felt than seen — Scarlatina papulosa. Or in the 
further development of the papular form, miliary vesicles, about 
as large as a millet seed, with turbid contents, may appear on all 
parts of the body, but chiefly on the trunk — Scarlatina miliaris. 
Or the hyperaemia may be so intense, that under the influence of 
a hemorrhagic diathesis, exudation of blood into the superficial 
layers of the skin, into the subcutaneous cellular tissue, into the 
miliary vesicles, and even haemorrhages from internal and mu- 
cous membranes may occur — Scarlatina hemorrhagica. The scar- 
latinous exanthem is sometimes accompanied or followed by other 
forms of cutaneous disease, such as herpes labial es, acne, urticaria, 



1008 EXANTHEMATA. 

pemphigus, ecthema, varicella-like and pustular eruptions, suda- 
mina, boils, and in septic conditions even gangrene of the skin 
and the subcutaneous cellular tissue. 

2. An angina which consists in mild cases of a uniform redness 
of the fauces, associated in more intense forms with swelling of 
the mucous membrane, enlarged follicles and tonsils in variable 
degrees. In still graver forms the mucous membrane is of a 
dark, livid color, greatly swollen, with abundant secretion, at 
times making deglutition considerably difficult, or impossible, the 
fluid taken regurgitating through the nose ; the tonsils are also 
greatly enlarged and prone to suppurate. In the severest cases 
(angina maligna) there is parenchymatous inflammation of the 
tonsils, and infiltration of the region of the parotid and sub- 
maxillary glands, frequently of the entire cellular tissue of the 
neck, of the retro-pharyngeal and laryngeal cellular tissue, which 
latter causes respiratory disturbances similar to those of oedema 
glottidis. There is great proneness of these swellings to suppu- 
ration, and even gangrenous destruction of the same has occurred. 

Scarlatinous angina is often complicated with diphtheria, which 
may stay confined to the throat or spread to the nose, larynx and 
the contiguous portions of the respiratory mucous membrane; 
it can be a complication of the mildest, as well as of the severest 
cases. Some authors consider the diphtheritic inflammation as a 
direct effect of the contagion of scarlatina. 

3. An inflammation of the kidneys, which may be of a catarrhal 
or parenchymatous nature. In the catarrhal form we find large 
masses of epithelial elements in the urine ; it occurs mostly in 
the early stages of scarlet fever. The parenchymatous form is 
attended with albuminuria and hsematuria, and occurs, as a rule, 
not before the end of the second or third week, but at times in the 
beginning ; it is accompanied with dropsical effusion, mostly as 
anasarca, though hydrops of the serous sacs may also be associ- 
ated with it. 

It should be understood that scarlatina is an exceedingly vari- 
able disease. There are cases without eruption, which are some- 
times followed by a more or less well-marked and extensive 
desquamation ; there are rare cases without angina, yet decidedly 
marked by kidney disease, parotitis and infiltration of the cervi- 
cal connective tissue; there are cases where the eruption follows 
an attack of nephritis, or parotitis, or infiltration of the cervical 
connective tissue, with or without angina. And even these 



SCARLATINA. 1009 

different varieties may be combined in the most complicated 
manner. 

Scarlatina is a contagious disease, not only by contact and im- 
mediate exhalation, but also by transmission through persons 
who are not themselves affected. The nature of the poison is 
not known. The stage of incubation lasts from four to seven 
days, or longer. The predisposition to take the disease seems to 
be not nearly as universal as that for taking measles, quite a 
number of persons escape it altogether. Infants less than six 
months of age are mostly exempt from its attacks; but children 
between the ages of one to fifteen years are most liable to catch it; 
in later years the disposition to it decreases greatly; scarcely any 
one gets it a second time, but there are exceptions. It generally 
appears as an epidemic, and the different epidemics vary much 
in character, severity, time of year, and duration. Its normal 
progress has been divided into four stages : 

1. The stadium podromorum commences with repeated chills, 
followed by heat, nausea, vomiting, violent headache, and a feeling 
of prostration. The pulse ranges from one hundred and twenty 
to one hundred and thirty and more beats per minute, and the 
temperature often reaches on the evening of the first day the 
height of 104° to 105.8° F. This is quite characteristic of normal 
cases, as no other disease shows such a rapid increase of pulsation 
and temperature. Besides these symptoms the patient commen- 
ces to complain of sore throat, dryness, and burning, and pain 
when swallowing. On inspection we find the throat red and 
swollen, and the tongue coated, but red on its edges. This con- 
dition lasts in some cases only a few hours; in others it is entirely 
absent, or so mild, that it may be overlooked, the eruption ap- 
pearing at once, while in a majority of cases it lasts one or two 
days, and quite exceptionally still longer. So, also, varies the 
intensity of the attack in. different individuals; from a mere 
indisposition, which is scarcely noticed, it may at once be asso- 
ciated with stupor and convulsions. 

2. The stadium eruptionis is almost always accompanied by an 
exacerbation of the fever. The eruption shows first on the neck, 
not, as in measles, on the face, which remains unchanged, pre- 
senting only feverish, reddened cheeks. From the neck it spreads 
further over the body, so that usually in twenty-four or thirty- 
six hours the whole body is covered. The deepest redness ap- 
pears on the neck, on the extensor muscles, around the joints, 

64 



1010 EXANTHEMATA. 

and on the dorsum of the'hands and feet. Pressure with a finger 
upon the skin causes, for a moment, a white spot, which speedily 
grows red again from the periphery to the centre, unlike that in 
measles, which spreads from the centre to the periphery. As the 
eruption grows and spreads, so, also, grows the angina faucium, 
and the thick, white coating of the tongue is now peeling off, 
leaving it red all over with highly-inflamed papillae, constituting 
the so-called strawberry tongue. The skin itches intensely. All 
these symptoms are not, however, alike in all cases. In some 
the redness may spread almost simultaneously all over the body 
and be very intense; it may be either scarcely noticeable or of 
different aspects, as described above; the angina also may amount 
to scarcely any thing, or be very intense; it may be complicated 
with diphtberitis, or be combined with catarrh of the larynx or 
bronchial tubes. 

3. The stadium florescentise, the time during which the eruption 
remains upon the skin, lasts usually from four to five days: 
about the second day of this stage it is in its fullest bloom; 
at the same time the fever and throat symptoms reach their 
height. The urine contains considerable quantities of cast-off 
epithelial cells, and frequently traces of albumen; in general the 
patient is sickest at this stage. It is the climax of the disease. 
From this time all the symptoms grow milder; the eruption de- 
clines, the fever lessens, the angina gradually lessens, and the 
patient feels better altogether. Yet this is not uniformly the 
case. The fever may rise anew, because new complications set in. 

4. The stadium desquamation! s sets in usually on the fifth day 
after the eruption first appeared, and lasts from eight to fourteen 
days. At first we observe fine white scales peeling off on the 
neck, the desquamation extending gradually over the whole 
body. On the hands and feet great flakes of skin are often 
loosened by the patient himself, as a wholesome pastime after so 
severe an illness; fever and angina lessen constantly, until finally, 
in about three or four weeks from the commencement, perfect 
recovery takes place. This is the normal course of a simple 
scarlatina case. 

The Scarlatina maligna, Typhosa, is characterized in the following 
way: In the premonitory stage already the patient is greatly 
prostrated, apathic, only half-conscious or comatose; the pupils 
are mostly dilated; there are either simply slight twitching? and 
jerkings of the limbs, or general convulsions; the tongue is dry; 



SCARLATINA. 1011 

the pulse very small, and scarcely countable; the body is burn- 
ing hot, with cold extremities. The eruption is either intense, 
breaking forth suddenly all over, and peeling off very soon in 
large flakes, as though the skin had been scalded. Such patients 
die, and, it seems to me, for this physiological reason, that life 
cannot be sustained if a certain amount of the surface of the skin 
becomes destroyed. In other cases the eruption does not come 
out regularly, looks purple, livid, and is mixed with ecchymosed 
spots; diarrhoea and meteorism associate, and the tongue and 
gums become covered with a black coating. Also such patients 
die mostly in the second stage, or sink during the stage of des- 
quamation. 

Another bad form is that of Angina maligna, a parenchymatous 
inflammation of the tonsils and fauces. We observe in such cases 
great difficulty, even impossibility of swallowing, and a nasal 
twang when speaking. The tonsils are greatly swollen, closing 
up the fauces; all the parts appear dark red ; there is an abund- 
ant secretion in the throat, in consequence of which the breath- 
ing becomes rattling ; the fever rises high ; the face is red and 
bloated, and the conjunctiva injected ; there is great restlessness 
and anxiety. This condition terminates either in the formation 
of abscesses, or in gangrenous destruction of the parts. The first 
is the more favorable of the two. In case of gangrene we see a 
blister forming which bursts, and then gangrenous ulcers spread- 
ing rapidly in circumference, but less in depth, emitting a terri- 
ble stench. All this is attended with violent fever heat, very 
frequent pulse, coma with half-open eyes, great restlessness, sud- 
den screamings, obstruction of the nose, difficulty of breathing, 
cold extremities, and retention of feces and urine. If the gan- 
grenous process comes to a halt, the patient may recover, though 
very slowly; if it continues the patient dies within two or three 
days. In the latter case the color of the eruption grows livid, 
and does not disappear under the pressure of the finger. 

Or the sore throat may be complicated with diphtheria and 
consequent infiltration of the parotid, submaxillary, and lym- 
phatic glands. This diphtheritic process may extend up into the 
nose (compare Diphtheritis) and cause a virulent coryza, that 
much-dreaded symptom of scarlet fever, with fetid discharge from 
the nostrils, and a terrible smell from the mouth. At the same 
time the cervical glands and the connective tissue around them 
tumefy ; the patient lies in a stupid or comatose state, with his 



1012 EXANTHEMATA. 

head bent backwards ; the pulse ranges from one hundred and 
forty to one hundred and sixty per minute, and the temperature 
of the body 106° F. and over. Should this morbid process ex- 
tend into the larynx, there are small chances left for recovery. 
In some cases the inflammation spreads along the Eustachian 
tubes into the tympanum, causing an otitis media, which may 
lead to perforation of the membrana tympani, and caries of the 
petrous portion of the temporal bone. 

In other cases the infiltrated cervical glands suppurate, accom- 
panied by a new increase of fever, causing various meningeal 
symptoms. At this stage not very unfrequently the synovial 
membranes inflame also, or pleuritis or pericarditis may sud- 
denly set in, followed by an abundant purulent exudation. 

During the period of desquamation most generally the third 
localization of the scarlatinal virus takes place, that into the 
kidneys, causing parenchymatous nephritis, with its subsequent 
scarlatinal dropsy. There are epidemics where almost all patients 
show symptoms of it — albumen and blood in the urine and drop- 
sical swellings, while in others they are only exceptionally ob- 
served. It usually sets in with renewed chilly sensations, which 
are followed by fever, nausea, vomiting, pain in the region of the 
kidneys extending along the course of the ureters, with frequent 
desire to pass a little dark, dirty brownish looking urine, which 
contains blood, albumen and epithelial cells. 

Still another sequel of scarlet fever is to be mentioned : dropsy 
without albuminuria, which generally creeps on slowly and may 
attain to a great height ; it is generally not so dangerous as that 
caused by nephritis, seems to be the consequence of loss of solid 
constituents of the blood, or a weakness of the heart, and is charac- 
terized by great weakness of the muscles, great paleness of the 
skin, great acceleration of the pulse from slightest motion, and 
fainting fits. 

The chronic otorrhcea after scarlet fever is mostly the conse- 
quence of a catarrhal inflammation of the meatus auditorius 
externus, while deafness has its cause in an inflammation of the 
middle ear, which has spread there through the Eustachian 
tubes, and caused perforation of the tympanum, or thickening 
of the same. 

Another sequel of scarlatina is oedema of the lungs, which usu- 
ally is complicated with hydrothorax and anasarca. Under con- 
stantly increasing dyspnoea and cyanosis the patient dies from 



SCARLATINA. 1013 

asphyxia. The same takes place, if oedema glottidis should be 
added to the pulmonary oedema. 

In our Prognosis we must consider as unfavorable symptoms : 
sudden disappearance of the eruption, which is always a sign of a 
dangerous complication; sudden change of the scarlet into a livid 
color, with rise of temperature and great frequency of the pulse, 
delirium or coma; purplish color of the eruption with eeehymoses 
or petechia?, bleeding of the gums, bloody alvine discharges, 
which denote a dissolution of the blood; intercwrmg diarrhoea or 
dysentery with meteorism, great thirst and sudden loss of strength ; 
diminished secretion of urine, ivliicli contains albumen and blood; hi- 
tercurring oedema of the lungs or glottis; gangrene of the tonsils and 
fauces, and diphtheritic inflammation of the throat. 

THERAPEUTIC HINTS.— As a preventive I would still recom- 
mend the potentized Belladonna, one dose every night, until symp- 
toms appear, v If it cannot prevent the attack, it has seemed at 
least to mitigate its violence. The clumsy imitation by the old 
school — drop-doses of the tincture or extract — could not possibly 
produce any beneficial results. 

The terrible burning and itching of the skin is best relieved 
by rubbing the body all over with bacon (fat part of ham), olive- 
oil, or cocoa-butter, once or twice a day, always if the skin is 
dry, glands swollen, and there is a scrofulous diathesis. 

When the temperature of the body rises to 106° F. and over, 
it has been found beneficial to envelope the whole body in a wet 
sheet ; I would prefer warm to cold water. 

Where there are several children in a family, the rest should 
be kept away from the sick-room. 

For complications with diphtheria compare the corresponding 
chapter. 

Aeon., rarely, and only in the very beginning of the attack, if 
characterized by the following symptoms : great dry heat and 
congestion of the skin ; thirst ; rapid and hard pulse ; great rest- 
lessness ; headache ; peevishness, which revolts against all inter- 
ference; or at a later period: sudden excruciating pain in the 
stomach, gagging, retching, vomiting of blood, and stoppage 
of breath ; distressed face, anguish ; cold sweat on forehead ; 
gasping. 

Ailanth., "violent vomiting; severe headache; intolerance of 
light; dizziness; hot red face; inability to sit up; small rapid 



1014 EXANTHEMATA. 

pulse; drowsy, at the same time very restless; great anxiety; 
two hours after the first invasion the drowsiness had increased to 
insensibility, with constant muttering delirium ; did not recog- 
nize the members of the family; she was now covered, in patches, 
with an eruption of miliary rash, with efflorescence between the 
points of the rash of a dark, almost livid color ; the patches be- 
tween the points of the eruption were of a dingy, dull, opaque 
appearance ; the eruption was more profuse on the forehead and 
face than elsewhere, and especially on the forehead ; the pulse 
was now small, and so rapid as hardly to be counted ; the surface 
had become cold and dry; the livid color of the skin, when 
pressed out by the finger, returned very slowly; the whole was a 
most complete picture of torpor." These toxical symptoms, 
caused by Ailanthus and observed by Dr. Wells of Brooklyn, 
simulate so strikingly adynamic forms of scarlatina that it must 
be a curative agent in such cases. Has since been confirmed by 
Dr. Chalmers and others. 

Amm. carb., hard swelling of the right parotid and lymphatic 
glands of the neck; putrid sore throat; miliary form of eruption. 

Apis is, according to Wolf, indicated in usual as well as in 
those grave cases where the blood is thoroughly poisoned by the 
virus, and the whole nervous system under its paralyzing in- 
fluence ; the fever assumes a typhoid character ; the tongue is of 
a deep red color, and covered with blisters, which become con- 
verted into sores and ulcers, with stinging pains ; the nose dis- 
charges a thick, white, bloody, fetid mucus; the tonsils are 
swollen and hard, and the swallowing difficult ; the whole ab- 
domen is sore to the touch ; the discharges from the bowels are 
diarrhoeic, slimy and bloody; nephritis; the urine is scanty, and 
of a dirty red color; micturition frequent and sometimes painful ; 
the breathing is accelerated and labored; there is loss of con- 
sciousness, delirium, sopor, convulsions, trembling of the limbs ; 
the skin is either burning hot all over, or gradually growing 
cool, or hot in some and cool in other places; the fever rises con- 
stantly, and the pulse changes frequently in character; dropsical 
symptoms during desquamation. — Cerebral irritation ; piercing 
shrieks; rolling of the head; grating of teeth: irregular, slow pulse. 
—"Apis is never indicated in the coryza form, only with a dry 
nose, dryness of the throat, and hydrocephalic symptoms." 
(Hering.) 

Arsen., when the eruption delays or grows pale suddenly, livid, 



SCARLATINA. 1015 

or is intermixed with petechia;; malignant sore throat; different 
dropsical affections; dyspnoea; extreme restlessness and anxiety; 
prostration; typhoid symptoms; cold hands; burning heat in- 
ternally, with a cold external surface; cold perspiration; quick, 
small pulse. Nephritis albuminosa. 

Arum triph., great soreness of the mouth ; redness of the tongue, 
with elevated papillae ; cracked corners of the mouth and lips ; 
stoppage of the nose, without or with profuse yellow discharge, 
filling the whole nasal cavity and throat ; putrid sore throat ; 
diphtheria ; submaxillary glands swollen ; urine abundant and 
pale ; eruption all over the body, with much itching and restless- 
ness; picking at the nose, lips, and finger-nails. 

Asclep. syr. is recommended for dropsy in consequence of ne- 
phritis. 

Baryt. carb., swelling of the parotids, tonsils and submaxillary 
glands, with much saliva, or else dryness in the throat, with 
pressing, stinging pain on swallowing. During and after des- 
quamation. 

Bellad., congestion to the brain, with delirium ; on closing the 
eyes he sees horrible things ; wants to sleep, but cannot sleep ; 
anxious dreams; starts in sleep; suddenly springs up in bed, or 
attempts to ; throbbing of the carotid arteries ; involuntary mov- 
ing of the hands to the head; bending the head backwards; head 
hotter than the remainder of body ; eyes injected ; face fiery red, 
or pale and puffed, or sunken ; tongue white, with red edges, or else 
red all over, with raised papillae ; fauces inflamed, swollen ; can- 
not swallow, or only with greatest difficulty ; external swelling 
of the neck; vomiting. (Bellad. is only indicated in the smooth 
form of eruption with vascular and nervous excitement ; it does 
no good in adynamic cases. The miliary form of eruption is 
much more adapted to Amm. carb., Laches., or Ehus tox.) 

Bromium, when the parotids became involved, especially the 
left, it did better than any other remedy. (W. Payne.) 

Bryon., when the eruption delays or suddenly disappears ; be- 
ginning dropsical symptoms ; pleuritis or meningitis. Crimson- 
red face ; dry lips ; dry, brownish tongue ; great thirst, and 
drinking much at a time and hastily; obstruction of the bowels; 
sleep with eyes half open ; disinclined to move ; pain on 
moving. 

Calc. carb., after Bellad., about the third day ; great, hard swell- 
ing of all the glands about the neck ; greatly inflamed throat, 



1016 EXANTHEMATA. 

with aphthae on the tonsils and roof of the mouth ; the pale, 
bloated face shows no signs of eruption ; great anxiety and op- 
pression, threatening paralysis of the lungs ; scrofulous individ- 
uals ; longing for boiled eggs. Otorrhcea as a sequel. 

Camphora, in desperate cases, with rattling in the throat ; hot 
breath, hot forehead, with hot perspiration; limbs cold and 
purple. 

Carbol. ac, a case by Dr. Rouht: sleeping uneasily with half open 
eyes; twitching of hands and limbs; starting from sleep; delir- 
ious talking; moaning; tossing; pulse 160; tongue thickly coated 
in centre, afterwards clearing and leaving it of a glossy, red 
color; throat swollen inside and outside; difficult swallowing and 
breathing; nose stopped up; lips dry and cracked; odor of 
breath almost unbearable; fauces fiery red and swollen; diph- 
theritic patches on tonsils and pharynx; urine scanty and red; 
bowels moved every hour ; eruption of a dark red color ; miliary 
vesicles over the entire body. 

Carb. veg., in last stage; rattling in the throat; complete sinking 
of vitality; cool breath; cool extremities; sticky, cold perspira- 
tion ; wants to be fanned all the time. 

Coffea, as an intermediate remedy for excessive nervous excite- 
ment, sleeplessness and palpitation of the heart. 

Colchic, nephritis ; bloody urine, looking almost like ink and 
containing albumen ; dropsy. 

Cuprum, when the eruption quickly disappears, with subsequent 
convulsions, rolling of the eyes, distortions of the face, mouth 
and all the flexor muscles ; great restlessness, tossing about ; 
sopor ; delirium. (No eruption, but terrible sore throat ; delirious, 
fearing the bed clothes would catch fire, etc. ; afraid of every one 
who approaches; afraid of falling; clinging tightly to the nurse; 
afraid of being injured by any one else ; conscious, knows other 
people; won't stay in bed, but on the lap.) (R. Gardiner.) 

Digit, nephritis after desquamation, with anasarca and oedema 
of the lungs. 

Gelsem., has been given in large doses to " control the pulse, 
calm the nervous erethism, determine the eruption toward the 
surface, relieve pain and lessen the cerebral congestion." I 
believe its proper homoeopathic sphere of action will be found 
rather in those asthenic forms of scarlet fever, which from the 
commencement show marked signs of a general toxication of the 
blood by the scarlatinal virus, viz. : profound and intense pros- 



SCARLATINA. 1017 

tration of the whole muscular power ; cerebral intoxication ; 
pulse frequent, soft, weak and so feeble as sometimes to be imper- 
ceptible ; impaired vision ; spasms and paralysis. Dr. Morgan 
gives the following hints : Chilliness, or at least cold hands and 
feet ; heat with languor and drowsiness ; when sleeping, the patient 
talks in delirious muttering, or half wakes at times; crimson 
flush of the whole face in all positions ; suffusion of eyes, heavy 
looking ; throat feels as if swelled or filled up, is diffusely red ; 
tonsils red and slightly swollen ; when the eruption recedes, all 
the viscera are threatened. 

Helleb., dropsical symptoms, in consequence of nephritis ; urine 
with sediment like coffee grounds; squinting; pupils dilated; 
face pale and puffed. 

Hepar, after previous abuse of mercury. Best remedy for com- 
mencing nephritis. (Kafka.) 

Hydr. ac, has been suggested by Dr. Wells, when the eruption 
in its early appearance is dark-colored and soon becomes livid, 
only slowly regaining its color when this is expelled by the press- 
ure of the end of the finger ; rapid, feeble pulse. 

Hyosc, stupid drowsiness, or else great nervous excitability and 
sleeplessness ; utter stupidity, or else illusions of the imagination 
and senses ; vacant staring at things, or else sparkling red, prom- 
inent eyes ; embarrassed, indistinct speech ; answers no questions, 
or else indistinct muttering loquacity; mouth and throat dry 
and red ; inability to swallow ; abdomen distended, tympanitic ; 
watery, involuntary and unnoticed stools in bed. " Its sphere 
seems to be limited to cases with acute inflammatory affections 
of the brain, or to that state between erethism and torpor, which 
places it in relation to Bellad. and Stramon., as in typhoid fever, 
below Stramon." (P. P. Wells.) 

Iodium, after mercury; ulcers in the throat; glands swollen, 
suppurating ; everything appears bright blue to him in the dis- 
tance; worse from warmth and from warm things of all kinds. 

Kali bichr., diphtheritic inflammation ; discharge from nose is 
tough and stringy ; pain in left ear ; swelling of parotid glands ; 
croupy cough ; measle-like eruption ; red, raw, glistening tongue; 
deep ulcers in the fauces. 

Kali carb., swelling of the right parotid gland ; fever and rest- 
lessness ; always worse about three o'clock in the morning ; smell 
from the mouth like that of old cheese; great dryness of the 
skin ; oedematous swelling, like little bags, between the eyebrows 
and upper eyelids. 



1018 EXANTHEMATA. 

Laches., miliary form of eruption ; also when the eruption turns 
purple at a late stage; in malignant cases with threatening gan- 
grene or sloughing ulceration; acrid, foul secretions; low grade 
of inflammatory action; approaching to a condition of torpor. 
Diphtheritic inflammation of the throat; fluids regurgitate 
through the nose; ulcers on the tongue; suppuration of the 
glands of the neck ; pleuritic, pericarditic and general dropsy in 
delayed desquamation, with great oppression; nephritis with 
urine almost black; badly smelling stool; fever worse in the 
afternoon. 

Lycop., diphtheritic sore throat ; stoppage of the nose ; rattling 
in the throat; comatose state; deafness and purulent discharge 
from the ears; great peevishness; crossness on getting awake; 
worse from being covered too much ; scanty, dark red and albu- 
minous urine, with strangury; oedema of the face, hands and 
feet ; ascites ; secondary eruption of dark red blotches on hands, 
thighs, back or face; colic during desquamation, with costive- 
ness. Is sometimes indicated at the onset. 

Mercur., consecutive anasarca and ascites; soreness and inflam- 
mation of the genital organs. 

Merc, jod., after Laches.; loss of voice, hoarseness, can only lisp ; 
fauces bluish-red, ulcerated. 

Mur. ac, intense redness rapidly breaking out all over the 
body in the first hours of the attack with coma; or scanty erup- 
tion, which is interspersed by petechias; dark redness of the face; 
purplish color of the skin; burning heat of the body; great anx- 
iety and restlessness, constantly compelling the patient to uncover 
himself; aggravation in the evening; pulse intermitting at reg- 
ular intervals; severe angina; dark, bluish-red fauces, aphtb.se; 
foul breath ; discharge of thin, acrid pus from the nose and lips; 
sighing, groaning respiration; sliding down in the bed. 

Nitr. ac, diphtheritic sore throat extending up into the nose, 
from which a profuse, thin, purulent matter discharges; tonsils 
swollen; tongue dry, fissured; difficult deglutition; indistinct 
speech; sometimes deafness; intermitting breathing ; eruption of a 
fine, miliary nature ; skin burning hot. 

Opium, convulsions, delirium, and a soporous condition, with 
snoring, which were not relieved by Bellad. 

Phosphor., after Mur. ac, although, on the whole, the patient be 
improving, a suspicious rattle commences in the throat; also by 
prevailing chest-symptoms; likewise in case of oversensitiveness 



SCARLATINA. 1019 

of all the senses, and yet an apathetic quietness and "don't-care" 
disposition appears; burning in different parts of the body, 
which compels change of position. Copious coryza; alarming 
weakness and increasing frecpuency of pulse; during night, hands 
cold and bluish ; congestion to the head. 

Phosph. ac, complete apathy and indifference; don't want to 
talk ; answers slowly and reluctantly, or short, incorrectly; stupor; 
stupid expression of the face; bleeding from the nose; meteoris- 
tic distension of the abdomen, with a great deal of rumbling and 
gurgling, and unpainful, watery, grayish diarrhoea; involuntary 
stools; great debility; ecchymosed spots; bluish spots on the 
parts which the patient lies upon ; pulse weak, frequent, inter- 
mitting ; profuse sticky sweat. 

Phytol., eruption dry, of a shriveled appearance ; in passing the 
hand over the skin it feels like brown paper ; urine suppressed ; 
hands and feet burning hot, cannot keep them covered ; restless 
and sleepless ; tongue dry in centre ; sides coated brown ; throat 
covered with a diphtheritic deposit of an ash color. (C. A. Sibly.) 

Rhus tox., when, after Belladonna, about the third day the fever 
is still rising; when the eruption of the miliary kind looks dark; 
when the eyes appear swimming, as if intoxicated ; when the 
tongue grows red and smooth, and a drowsy state, with delirium, 
sets in ; great restlessness ; bleeding from the nose at night ; rheu- 
matism of the joints, worse in rest ; oedema of the scrotum and 
penis ; the swollen, parotid glands break open and discharge ichor 
copiously ; impure, deep cavity, as if one could see into the throat; 
first the left, then the right. Often indicated at the onset of the 
miliary form. 

Secale, watery discharge from the nose and yet a stoppage of the 
nose ; bloody and albuminous urine ; cannot bear the heat of the 
stove, or remain covered. 

Senega, oppression ; rattling in the chest ; loose but feeble cough, 
with little expectoration ; hydrothorax. 

Silic., fever worse at night; sleep disturbed by pain in the ears; 
child wakes up throwing the arms about and screams ; puts the 
hands behind the ears ; otitis media ; if sickly after vaccination, 
or soon after, scarlet fever follows ; like to be covered, wrapped up. 

Stramon., similar to Belladonna cases, but "the eruption is less 
bright, shows a disposition to fade or recede, and the urine is 
small in quantity or its secretion suppressed." (P. P. AVells.) 
Parenchymatous nephritis ; delirium, hallucinations, convulsions. 



1020 EXANTHEMATA. 

Great dryness of the throat, compelling frequent drinking ; swell- 
ing of the tongue, so that it hangs out of the mouth; paralysis 
of the tongue. 

Sulphur, rapidly growing red all over, and intensely so, with 
following sopor soon after the first vomiting ; burning heat of the 
skin ; eruption at first bright, soon growing purple, attended with 
diarrhoea, worse in the morning. Cerebral disturbances, with 
sopor, starting, etc. ; bloated, shining red face with white circle 
around the mouth; dry nose; dry, cracked and red tongue. 

Tereb., especially when the kidneys become involved with pa- 
renchymatous inflammation and its smoky, bloody urine. "Al- 
buminuria and dropsy after scarlet fever; urine greenish, scanty, 
loaded with albumen; much thirst, drinking often and much at 
a time." (J. B. Bell.) 

Veratr., in hot summers; burning heat changing with cold- 
ness of the extremities ; small, frequent pulse. 

Ver. vir., according to western physicians, in large doses, rather 
antipathically, to subdue arterial excitement, Convulsions with 
great!} 7 dilated pupils, perfect sleeplessness. Red streak down 
the centre of the tongue. 

Zincum, especially in threatening paralysis of the brain ; com- 
plete unconsciousness; the child lies perfectly motionless ; jerk- 
ing of the whole body, or twitchings of single limbs; grating of 
the teeth ; shrill, frightful screams, with altered voice ; cannot 
speak any more ; occiput very hot ; forehead cold, covered with 
cold perspiration ; white, pale, distorted face ; breathing short 
and quick, but no rattling; discharge from the bowels and blad- 
der involuntary; limbs icy cold, and the whole body cool; bluish- 
red all over ; pulse thread-like, scarcely countable. "Convulsions, 
followed by stupor ; occiput hotter than forehead ; screams before 
the spasms ; trembling of the muscles ; constant motion of the 
feet between attacks ; urine scanty, bloodv." 



Rubeola, Roe the In. 

The many different views as to the nature of this disease, 
whether it be a hybrid affection of scarlet fever and measles, or 
an affection distinct from either of the two, seem now to settle 
down in favor of the latter view. For an attack of rubeola pro- 
tects neither against measles nor scarlet fever, and vice versa. 

Rubeola is contagious, appears in epidemics. Its stage of in- 



RUBEOLA. 1021 

cubation lasts probably from two and a half to three weeks ; pro- 
droma are scarcelj r ever observed. The breaking forth of an ex- 
anthem is the first, or at least among the first symptoms of the 
disease. It commences on the face and spreads gradually in a 
downward course all over the body. With it there may be an 
increase of temperature from 2° to 4° F. above the normal, 
though usually it amounts only to about 1.5° F., or there is 
none at all. The rash has great similarity with that of measles, 
but the rubeola spots are smaller, rounder in form and paler 
in color. Sometimes it is accompanied with some sneezing, 
coughing, slight photophobia, sore throat, and some slight tran- 
sitory disturbance of the appetite. Affections of the kidneys do 
not occur. Desquamation is absent in most cases. The dura- 
tion of the exantbem is often scarcely two, but sometimes four 
days. Eecovery takes place undisturbed after its disappearance. 
The whole process seldom needs medicinal interference. For 
the catarrhal symptoms either Aeon., Bellad., or some other 
remedies may be indicated. 

Variola, Small-Pox ; Variolois, Varioloid. 

The nature of the variola virus we do not know, except by its 
effect upon the organism. It is regenerated while it develops its 
effects, and thus propagated from organism to organism. The 
infectious matter is contained in the variola pustules as well as 
in the exhalation from the small-pox patient. Infection takes 
place, therefore, not only by inoculation or immediate contact 
with the patient, but also by more remote means. The poison 
can be carried by other persons in their clothes, or by things 
which have been in the atmosphere of the patient. It is very 
persistent in its nature, and may retain its property for years if 
excluded from the atmosphere, and not exposed to great heat. 
There is no difference between the virus of small-pox and that 
of varioloid ; either may cause the one or the other disease. This 
seems to depend entirely upon the susceptibility of the organism, 
and its adaptation for a greater or less development of its effects. 
Small-pox and varioloid differ, therefore, only in the intensity 
of their symptoms. The individual predisposition for taking 
the disease is wide-spread; no sex, no age, not even the foetus is 
exempt ; some persons, however, are never affected by it. Those 
who once lived through an attack are, almost without exception, 



1022 EXANTHEMATA. 

safe from any further infection, at least for a long time. Vacci- 
nation seems likewise to destroy the predisposition to the dis- 
ease ; if not in toto, at least partially. For, ever since vaccina- 
tion has become generally introduced, the epidemics have grown 
decidedly milder, the majority of cases being varioloids, while 
previous to the discovery of vaccination, the reverse was the rule. 
Nevertheless, there are epidemics which are still characterized 
by great malignity, while others again are exceedingly mild. It 
has not been possible to trace out any cause for this difference. 
This is one view of the vaccination question. Of late years, 
however, not only great doubts of the correctness of this view, 
but direct accusations of its falsity have been propagated by men 
as able as its defenders. The lively agitation in England and 
Germany against the coercion law of vaccination has produced a 
whole library on this subject, and will make itself felt more and 
more every year. The statistic assertion that small-pox epi- 
demics have become milder since the general introduction of 
vaccination, is flatly contradicted by the researches of the fore- 
most statistician of Germany, Dr. Engel, in Berlin, who already 
in the year 1862, had to confess, "there has no change occurred 
in the coming and going of small-pox epidemics, nor in general 
in the number of small-pox patients since the introduction of 
vaccination." (Zeitschrift des Kb'nigl. Preussischen Statist. Bureaus, 
February, 1862). But it does not lie in the sphere of this work, 
to reproduce the details of this contention ; my belief is, that 
vaccination after a few generations will be as obsolete in medical 
therapeutics as inoculation, blood-letting and kindred barbar- 
isms of old are to-day. 

Its Coukse and Symptoms. After the lapse of nine or ten, 
sometimes more days of incubation, the initial stage, or the 
stadium invasionis, begins with a shaking chill, or repeated chilli- 
ness, which is followed by a violent fever. The temperature rises 
on the first day to 103° or 104° F., and on the second or third day 
to 105° or 105.5°, and even 107° F. This high fever is accompa- 
nied with a number of painful symptoms of the head, throat, 
stomach, and general body; in some cases with delirium and 
convulsions. No other, however, is so characteristic of the dis- 
ease as the dreadful backache, with which it is in most cases asso- 
ciated. The fever rises continually during the first three days, 
showing slight remissions only in the morning. On the even- 
ing of the third day it reaches its height. Only in rare cases is 



VARIOLA, SMALL-rOX. 1023 

this premonitory stage absent. In some epidemics the initial 
stage is marked by an erythematous eruption, either diffuse or 
measly; or by a hemorrhagic exanthem, which consists of ex- 
tremely small punctate, often pin-head sized, haemorrhages in the 
epidermis, at times so closely crowded together, that the impres- 
sion of a diffuse redness is produced. Sometimes both forms are 
combined and we see, then, petechia? upon an erythematous base. 
The petechial eruption has its favorite seat on the lower region 
of the abdomen, on the genitals and the inner surfaces of the 
thighs, also on the lateral surfaces of the trunk up to the axillae, 
the contiguous portions of the arm and the pectoralis major mus- 
cle. This eruption generally appears on the second day and lasts 
from twelve to twenty-four hours. As a rule the petechial form 
lasts longer. 

The second stage, the stadium eruptionis, commences on the 
evening of the third day. There appear little red spots first on 
the face. If very numerous, they coalesce like measle-spots, with 
which they might be confounded if it were not for the granulated 
feel which the} 7 present to the sense of touch. On the second 
day the eruption appears on the neck, chest and back ; and on 
the third day it spreads over the extremities. The granulated 
feel of the eruption is due to the formation of papules in conse- 
quence of an enlargement of the cells of the rete Malpighii, 
which pushes the epidermis up. Soon an exudation of clear fluid 
from the papillary layer converts the papules into vesicles, and 
separating the cells into small groups, a reticulated cavity is 
formed, which contains pus- corpuscles and the epithelial frame- 
work. This is the reason why a pock never discharges fully if 
opened only in one place. After the formation in vesicles, most 
pocks show a central depression or umbilicus, which some think to 
be due to the presence of a hair follicle or the duct of a sweat 
gland in or over its centre ; others teach that the periphery of 
of the pock swells more rapidly than its centre, and thus becomes 
more prominent. This umbilicus disappears, when the pustule 
is fully ripe, but reappears again from the earlier drying of the 
centre. It requires about six days for the ripening of the pus- 
tules ; or counting from the time of invasion, nine or ten days. 
Simultaneously with this eruption on the skin, an eruption of 
the same character appears upon the different mucous mem- 
branes. On the conjunctiva it causes a flow of tears, photophobia, 
and in severe cases total closure of the eyes for many days ; in 



1024 EXANTHEMATA. 

the mouth it causes salivation; in the pharynx, difficulty of 
swallowing ; in the larynx, hoarseness and cough ; and in the 
genitals, itching and burning pain. Even the external portion 
of the dura mater has been found studded with pustules filled 
with matter. In several instances the suppuration was of such 
a character as to destroy the membrane where the pustules existed. 
(Report of Drs. Howell and Johnson, Small-pox Hospital, San 
Francisco. Epidemic of 1868. North American Journal, February 
1869, p. 443.) 

The full development of the eruption is generally attended 
with great relief to the patient; all the pains lessen and the 
fever decreases considerably. In cases of variola confluentes 
only, the relief is not so marked. This is, however, not the end 
of the trouble. 

On the ninth or tenth day the fever commences to rise again ; 
it is the beginning of the stadium suppurationis s. maturationis. 
At this time the pustules enlarge still more, the surrounding skin 
commences to inflame and to swell, and a red areola forms 
around each pustule. Redness and swelling coalesce from all 
sides, and constitute a diffused, erysipelatous appearance of the 
whole face, greatly .disfiguring the patient. This process gradu- 
ally spreads over the whole body, in the same order in which the 
eruption commenced to appear. The patient complains of great 
tension and burning of the skin, and the affections of the eyes, 
mouth, throat, larynx, and genitals increase in corresponding 
order. The temperature rises again from 102 and 103° to 104° 
F., frequently attended with chilly sensations ; it rises according 
to the intensity of the inflammation of the skin ; and does not 
abate until the dermatitis reaches its acme. This renewal of 
heat is called the secondary or suppurative fever. It may be at- 
tended with delirium, and symptoms of adynamia and general 
paralysis, in consequence of the absorption of pus into the blood. 
In other cases it combines with a hemorrhagic diathesis, when 
the content of the pustules becomes bloody, and bloody extra- 
vasation within the skin or haemorrhages from different mucous 
membranes take place, hemorrhagic small-pox; or, though only 
in rare cases, portions of the inflammation mortify and discharge 
a badly-looking ichor, gangrecnous small-pox. Besides all this, as 
the variola-poison is apt to localize during this stage in serous 
membranes and parenchymatous organs, we meet witli a num- 
ber of different * complications, such as : dyspnoea, stitching 



VARIOLA, SMALL-POX. 1025 

pains in the chest, cough, bloody expectoration, pneumonia, 
pleuxitis, pericarditis, meningitis, suppurative inflammation of 
the joints, periostitis, subcutaneous and inter-muscular ab- 
scesses, inflammation and suppuration of lymphatic glands, 
suppuration of the eyes with hypopyon, and croupous exudations 
in the larynx and trachea. 

The last stage, or the stadium exsiccationis, usually commences 
about the eleventh or twelfth clay. The pustules burst and dis- 
charge their contents, or dry up, and become covered with hard, 
brownish crusts. There is still some fever at first ; it lessens, 
however, continually, and with it gradually disappear all the 
painful symptoms which arise from the eruption on the different 
mucous membranes. The crusts now gradually drop off, at 
first those which cover the most superficial pustules ; they leave 
dark red, somewhat elevated spots, which, however, after some 
time, entirely disappear. Not so those which form upon deep- 
seated ulceration. They adhere a long time, and leave, after 
dropping off, an uneven scar, which looks at first red, but by de- 
grees grows conspicuously white, to remain so for life. In con- 
fluent small-pox the destructive process is of a still greater ex- 
tent, in circumference as well as in depth, and frequently the 
remaining scars greatly disfigure the face, similar to scars of 
deep burns. This is the course and progress of variola. 

Varioloid runs a similar but much milder course ; all its stages 
are milder and shorter ; its secondary fever is much less intense, 
or wanting altogether; and its suppurative process does not de- 
stroy the cutis, so as to leave scars. 

The Purpura variolosa represents the worst course which small- 
pox can take in the initial stage. It attacks young and robust 
persons by preference, begins with rigor, headache, very intense 
pain in the back, and great prostration. Within eighteen to 
thirty-six hours a scarlet-like erythema appears over the entire 
body, which is mingled with petechias and larger cutaneous 
haemorrhages, varying in size up to that of a silver dollar, which 
usually become confluent upon the chest and abdomen. The 
face is rendered red and puffy, the conjunctiva blood-shot, and 
large black rings are formed around the eyes, through haemor- 
rhage into the cellular tissue of the lids and their contiguous 
parts. The tongue is swollen and covered with a whitish-yellow 
coating, and the throat is affected with diphtheritic exudation, 
from which issues a terrible odor. There is pain in the pit of the 
65 



1026 EXANTHEMATA. 

stomach, nausea and vomiting of bile and blood, bloody diarrhoea 
and offensive urine. In some cases we meet a troublesome cough, 
with bloody expectoration, and in women, haemorrhages from the 
womb. The temperature rises to about 104° F. ; the intelligence 
is usually unimpaired until a short time before death, when the 
body, particularly the trunk, assumes a blackish, or leaden-gray 
hue. Some patients die within three days after the beginning, 
or even earlier, some survive the sixth day. (Curschmann.) 

Prognosis. — The fewer the pustules, the lighter the case ; con- 
fluent pustules are much more severe. Hemorrhagic, septic and 
gangrenous small-pox are not absolutely fatal, but very dangerous. 

When typhoid symptoms are added, the prognosis must be 
very guarded. 

The younger the individual the greater the danger. Very 
youug infants are always in great danger. 

In pregnant females it brings on abortus. 

Inebriates are liable to be taken with delirium tremens. 

Any of the complications mentioned makes the diagnosis 
doubtful. 

PREVENTIVES. — Vaccination is lauded and equally condemned. 
The humanized virus and the lancet have given place to the 
ivory point and the cow-pox virus. This is an improvement. 
Syphilis at least is thus prevented from being propagated any 
longer by vaccination. 

Internal vaccination is recommended and practiced by Dr. Kacz- 
kowsky, and consists in the administration of one dose of Sul- 
phur, 30 which is left to act for fourteen days, and is followed by 
the administration of Vaccininum, 4 or Variolinum. 4 About the sev- 
enth or eighth day febrile symptoms occur, and on the eighth, 
ninth or tenth day a granular eruption, of the size of poppy seeds, 
appears under the skin, which soon ripens and heals. This pro- 
cess has never been carried out to a sufficient extent so as to en- 
able us to judge of its efficacy. 

Dr. H. Boskowitz, of Brooklyn, recommends the virus of the 
malanders or grease of the horse either for inoculation, instead of 
cow-pox virus, or for internal use in a high trituration. The 
successful internal application of Malandrinum as a preventive has 
been confirmed this season (1880-81) by Dr. K. Straube and 
myself. Dr. Hering has advised the sprinkling of a weak solu- 
tion of cyanide of potassium about the house, because such me- 






VARIOLA, SMALL-POX. 1027 

chanics as use it in their manipulations, have been observed by 
Dr. Korndoerfer to be exempt from the disease in small-pox epi- 
demics, because the sulpho-cyanide of potassium, which is present 
in the saliva of the healthy, disappears from there in small-pox 
patients, and appears instead in the contents of the pock. This 
has been demonstrated by me about the year 1850. Still others 
have used Baptis., or Sarracenia, as preventives, with great suc- 
cess. Who shall gainsay it? They all were trustworthy ob- 
servers, and epidemics of small-pox change as much in their 
peculiarities as epidemics of scarlet fever or any other disease. 

THERAPEUTIC HINTS.— Apis, where there is an erysipelatous 
redness and swelling, with stinging, burning pains; stinging- 
burning pain in the throat ; dyspnoea ; suppression of urine. 

Arsen., in asthenic cases, with great sinking of strength, burn- 
ing heat, frequent small pulse, great thirst, great restlessness, and 
when the pustules sink in, and their areolae grow livid. 

Baptis., typhoid symptoms; pustules appear more thickly in 
throat than on skin. It proved exceedingly effective during an 
epidemic, preventing even the offensive effluvium. (E. "Williams, 
B. J. K, 1873, p. 344.) 

Bellad., during the first stage; high fever; congestion to the 
head ; sleeplessness, with desire to sleep ; convulsions. Later, 
sore throat and cough. 

Bryon., at the commencement, and also when the chest symp- 
toms indicate it. 

Calc. carb., very important during dentition. 

Camphora, in those dangerous cases where the swelling suddenly 
sinks in and the pustules suddenly dry up, showing a complete 
giving out of the life-forces. 

Carb. veg., when the eruption seems to recede, with cold ex- 
tremities, small, empty pulse, oppression of chest and harassing 
cough. 

Canthar., dysuria and bloody urine ; the eruption assuming a 
hemorrhagic tendency. 

Hepar, croupy cough; suppuration. 

Hydrast. can. has been given successfully when there was great 
swelling, redness, and itching, and great soreness of the throat. 
Is said to prevent the pitting to a considerable degree. 

Malandriniun, 30 has been given during the last epidemic (1880- 
Sl) by Dr. R. Straube, several others and myself with great sue- 



1028 EXANTHEMATA. 

cess as a preventive as well as a curative agent. It prevented the 
suppurative fever, or lessened it at least to a considerable degree, 
and took away all offensive exhalation. Cerebral symptoms, such 
as delirium and hallucinations necessitated the interposition of 
Stramon., while great soreness of the throat and cough required 
Bellad. An article on Malandrinum by Dr. K.. Straube, which 
contains a partial proving of this remedy, can be found in the 
North American Journal of Homoeopathy, August number, 1881. 

Mercur., especially during the suppurative stage ; great flow of 
saliva; dysenteric discharges from the bowels; syphilitic taint. 

Phosphor., hsemorrhagic diathesis ; bloody contents of the pus- 
tules; hard, dry cough; bronchitis; haemorrhage from the lungs. 
Typhoid form. 

Phosph. ac, typhoid conditions; subsultus tendinum ; great rest- 
lessness ; great fear of death ; the pustules don't fill with matter ; 
some degenerate into large blisters, which burst and discharge a 
watery fluid, leaving the surface excoriated ; watery diarrhoea. 

Rhus tox., typhoid symptoms, dry, cracked tongue; sordes on 
the lips and teeth : great debility and restlessness; the eruption 
shrinks and looks livid. 

Sarracenia has been used empirically, and is said by some to 
shorten and to ameliorate the progress of the disease; others 
deny it. The fact of it is, we do not know any characteristic 
indications of the remedy as yet. 

Sulphur is indicated where there is any tendency of metastasis 
to the brain during the suppuration; is indispensable occasion- 
ally as an intercurrent remedy when others seem to fail; and 
Goullon advises its uniform use in the stadium exsiccationis. 

Tart. emet. has been found by some to ameliorate the progress 
vi' the disease. 

Thuja, recommended by v. Bocnninghausen as a preventive as 
well as a curative agent. He states that it shortened in the epi- 
demic of 1849, in his neighborhood, all cases, and prevented 
all scars. 

Vaccininum lias been used undoubtedly with great benefit in 
small-pox; its use has shortened and ameliorated all stages quite 
considerably. Sulphur was given afterwards. 

Variolmum makes the progress of the disease much milder ; 
quickly removes all dangerous symptoms; changes imperfect pus- 
tides into regular ones, which soon afterwards dry up: promotes 
suppuration on the third day, and exsiccation on the fifth, sixth, 



VARICELLA, CHICKEN-POX. L029 

and ninth day, and prevents all scars. This is the unanimous 
testimony of ten physicians who have used it in different epi- 
demics. 



Varicella, Chicken- Pox. 

Some pathologists consider chicken-pox as the lightest form of 
variola. This cannot he. For experience teaches, that varicella 
does not extinguish the liability to either cow-pox or small-pox, 
and that an infection with varicella causes the identical varicella 
and not variola or varioloid. 

Varicellas often prevail epidemically, and we also find sporadic- 
cases. They frequently precede, accompan}' or succeed epidemics 
of small-pox, measles and scarlet-fever. 

They consist, at first, of little red spots, like flea-bites, which 
in the course of a few hours develop themselves into vesicles, 
filled with a transparent, straw-colored fluid. The form of these 
vesicles varies, and according to the different forms which they 
occasionally assume, they have been divided into varicdhc globu- 
losse, ovales, lenticulares, coniformes, cuminatse. Some of them often 
fill with pus and become varicella: picstulosse, leaving, after desic- 
cation, a scar. Their appearance, in most cases, is the first symp- 
tom of the disease, without any previous ailment. They spread 
irregularly over the body, and continue to appear in crops for 
several days, so that, when the first crop is already in a state of 
desiccation, a new crop shoots up. In this way the whole pro- 
cess may last fourteen days, and even longer. A similar erup- 
tion occasionally takes place upon the mucous membranes, and 
forms little ulcers in the fauces ; but that is not always the case. 
The general feeling of the patient is not very often material 1} T 
disturbed, though some cases are attended with fever, headache, 
cough, want of appetite and general indisposition. 

THERAPEUTIC HINTS.— It seldom needs particular treatment. 
The occasionally attending symptoms may be met by Aeon., 
Ant. crud., Bellad., Hyosc, Mercur., Pulsat., Rhus tox., Tart, cruet. 
Compare Variola. 



SKIN. 



The skin, as the exterior investment of the hody, serves to 
protect it; at the same time it is the medium by which a con- 
tinued exchange goes on between the interior organs and the 
outer world. It is the connecting link between them, the last 
and lowest of the human frame. Its affections are almost always 
tokens of some internal derangements, hence their suppression is 
almost always followed by an aggravation of internal troubles. 
On the other hand internal complaints get better in the same 
degree that the morbid process passes outwardly to the skin. 
This we might state in brief as the essence of Hahnemann's 
psora-theory, which has been thrown aside by the would-be-wise, 
who never understood it. According to Nunez the suppression 
of cutaneous eruptions on the anus is followed by liver com- 
plaints; on the legs, by digestive derangements; on the scrotum 
and penis, by impotence and seminal emissions; behind the ears, 
by cough and affections of the eyes; on the scalp, by pulmonary 
phthisis; on the arms and hands, by laryngeal phthisis; in the 
palms of the hands, by nervous asthma; on the nose and nostril>. 
by discharges from the ears; on the face (acne rosacea), by heart 
diseases. The skin being easily accessible to ocular inspection 
and microscopical investigation, its affections have been thor- 
oughly searched and minutely arranged and described, especially 
by Hebra. It would alone fill a large volume were I to give a 
minute investigation of this subject. For such there is no room 
in a work of this kind. I shall confine myself to a cursory 
exposition. Besides, several of these affections have been treated 
of in previous chapters. 

I. HYPERTROPHY OF THE SKIN. 

A hypertrophy of the entire structure of the skin we often find 



ICHTHYOSIS. 1031 

in single, confined places, constituting so-called moles, or mother's 
marks, and soft warts. They appear raised above the level of the 
skin, and, from large deposits of pigment within the rete Mal- 
pighii, they are of a dark brown color and covered by a luxuri- 
ant growth of hair. 

A hypertrophy of the epidermis, hard and horny, constitutes 
callosities, which form on such places as are exposed to external 
pressure, especially on the hands and feet. Corns, or clavi, are 
callosities, which grow on small, circumscribed places of the feet 
in consequence of the pressure of tight shoes. Horns, or cornua 
cutanea, consist either in an excessive, circumscribed hypertrophy 
of the epidermis or in enlarged hair-follicles. 

An abundant formation of pigment in the rete Malpighii causes 
a more or less dark color of the skin ; when accumulating in 
confined spots, without rising above the level of the skin, it con- 
stitutes naevi spili (mother's marks) ; lentigines (liver spots) ; ephe- 
lides (freckles) ; chlosmata uterina, that is, brownish spots on the 
forehead and upper lip during pregnancy, or in consequence of 
uterine disorders ; and the peculiar darkening around the nipples 
and the darkening of the linea alba during pregnancy. 

A hypertrophy of the papillary layer of the cutis constitutes 
ichthyosis. 



Ichthyosis, or Fish- Skin, 

Is, according to Hebra, always of a congenital or hereditary 
nature. The skin appears dry and rough, and covered with 
thickened and exfoliating cuticle, like scales, all over, with the 
exception of the face, the inner side of the joints and the scrotum. 
In light cases the skin presents merely a rough appearance, being 
covered with fine, white scales, without any sign of congestion or 
inflammation underneath. These light cases are called by some 
authors pityriasis, while other writers class under pityriasis also 
those cases where such small, whitish patches of unhealthy 
cuticle form upon a red, inflamed surface, calling it pityriasis 
rubra. It seems that the latter is a superficial dermatitis, and 
has nothing to do with a diffused hypertrophy of the papillary 
layer of the cutis. 

Compare Arsen., Calc. carb., Clemat, Graphit:, Hepar., Lycop., 
Petrol., Phosphor., Plumbum, Sepia, Silic, Sulphur, Thuja. 
Rubbing with oil, and afterwards taking a warm bath, is best 
suited to remove the hard scales. 



1032 ATROPHY, HYPEREMIA AND ANAEMIA OF THE SKIN. 

Hypertrophy of single papillx causes warts (verruca? vulgares), 
and fig-warts (condylomata). For common warts: Ant. crud., 
Calc. carb., Caustic, Dulcam., Natr. mur., Nitr. ac, Phytol., Rhus 
tox., Sepia, Sulphur, Thuja. For fig-warts compare venereal dis- 
eases. 

A circumscribed hypertrophy of the cutis constitutes so-called 
polypi of the skin, and the molluscum simplex, a hard, sometimes 
pediculated tumor. 

A hypertrophy of the cutaneous capillaries causes telangiectasias. 
Some of them remain stationary through life, while others en- 
large continually, and may give rise to profuse haemorrhages. 

Compare Bellad., Ferr. phosph., Lycop., Phosphor., Platina, Sulphur, 
and to which may be added: Calc. carb., Carb. veg., Fluor, ac, 
Pulsat., Thuja, 

II. ATROPHY OF THE SKIN. 

Atrophy of the entire skin takes place in consequence of general 
marasmus, either senilis or prsematurus, induced by exhaust- 
ing diseases. 

A want of pigment throughout the whole skin is congenital to 
albinos or kakerlakes. A disappearance of pigment in single 
places of the skin, vitiligo or achroma, gives, especially to dark 
persons, a white-spotted appearance. 

An atrophy of the hair-follicles causes baldness, cahities, or, as 
it happens mostly to aged persons, alopecia senilis. The falling 
out of the hair after severe illness depends merely upon a nutri- 
tive disturbance of the hair-follicles, not upon a wasting away of 
the same. Therefore the hair grows again as soon as these nu- 
tritive disturbances cease. 

A want of pigment in the hair makes it gray and white. 

III. HYPEREMIA AND ANEMIA OF THE SKIN. 

A stagnation of blood in the cutaneous capillaries, in conse- 
quence of heart disease, causes cyanosis. 

Hypertonia, or congestion of the skin, characterized by redness 
of the skin, is caused by exposure to heat: by the application of 
different irritating substances, such as mustard, cantharides, 
mezereum, etc. ; by a blow or fall ; by the different exanthematic 
diseases, and fevers of different descriptions. 



ERYTHEMA.. 1033 

Anaemia of the skin, characterized by great paleness of the skin, 
is always associated with a general anaemic stale of the system; 
moreover, it is induced by exposure to cold, and is quite a 
characteristic sign of chills. 

IV. DERMATITIS, INFLAMMATION OF THE SKIN. 

1. Erythema. 

Erythema is characterized by a diffused redness of the skin, 
which, under the pressure of the finger, disappears, and leaves 
not a white, but a yellowish spot, which at once grows red again. 
It gradually disappears and is followed by desquamation; it is 
always attended with more or less burning pain. Erythema is 
caused by exposure to heat, the rays of the sun, and by different 
irritating substances. "When it occurs in small children between 
the folds of the skin around the neck, behind the ears, between 
the thighs, etc., or in fat women under the dependent breasts, and 
becomes raw, it is called Intertrigo. It is found also between the 
buttocks, in consequence of friction from walking in hot weather. 
When erythema is the consequence of pressure from lying long 
in one position, as in severe illness upon the os sacrum, trochan- 
ters, or other prominent parts of the body, it is called Decubitus. 
So, also, do we observe erythema, in consequence of acrid dis- 
charges from the eyes, nose, bowels, and genitals upon the adja- 
cent parts. 

Besides all this there is an erythema, which, without any 
apparent cause, appears spontaneously upon the back of the 
hands and feet; in rare cases it spreads over the face and trunk, 
but never without, at the same time, showing itself upon the 
back of the hands and feet. It appears in these localities as an 
evenly diffused redness and swelling, which, after a short time, 
becomes covered with smaller, or larger, dark red, or even 
purplish-colored papulaa, Erythema papulatum seu tuberculosum. It 
is always attended with an annoying burning pain, and in some 
cases with feverishness. After a few days the redness, swelling, 
and papulae disappear, and the whole morbid process winds up 
with desquamation of the cuticle in the course of eight or four- 
teen days. In some cases it lasts longer, when repeated crops of 
papular eruptions follow each other in succession and on differ- 
ent localities. 



1034 DERMATITIS. 

The Erythema nodosum appears almost exclusively on the lower 
extremities of young persons. Upon the reddened skin lumps 
of the size of hazelnuts or walnuts appear, which are painful to 
the touch and have a great similarity to bruises, changing their 
color from red to purple, then to blue, and lastly to green and 
yellow. This form is always attended with feverishness and 
ends with desquamation after eight or fourteen days; only in 
rare cases new crops follow. 

THERAPEUTIC HINTS.— Intertrigo of infants between the thighs, 
when attended with acrid diarrhoea, compare Borax, Chamom., 
Mercur., Rhus tox., Sulphur. 

When behind the ears, Graphit., Petrol., Sulphur. 

In general, Lycop. 

Erythema from exposure to the rays of the sun, Aeon., Cam- 
phor, Canthar. 

Decubitus, Arnica. Carb. veg., China, Fluor, ac, Sulph. ac, etc. 
Compare the corresponding chapters. 

Erythema from acrid discharges, compare the corresponding 
chapters. 

Papulous erythema, compare Aeon., Bellad., Laches., Mercur., 
Rhus tox., Sulphur. 

Erythema nodosum, compare Arnica, Mezer., Laches., Ledum, 
Lycop., Ptelea trif., Rhus veil., Sulph. ac, Sulphur. 

2. Herpes. 

The different forms of herpes are characterized by an exuda- 
tion, usually of a watery substance, beneath the epidermis, form- 
ing globular vesicles which are arranged in clusters upon an in- 
flamed patch of the skin, and terminate frequently in the forma- 
tion of a thin incrustation, without leaving scars. 

. The Herpes facialis appears on the face ; when on the cheeks 
and upon the eyelids it is called Herpes pHyctaenoides, when upon 
the lips, Herpes labialis, or Hydroa febrilis (fever-blisters). This latter 
form is a frequent attendant upon croupous pneumonia, inter- 
mittent fevers, and other febrile diseases. It scarcely ever occurs 
in typhus. 

A special treatment is not required, but its presence may sug- 
gest Bryon., Graphit., Hepar, Natr. mur. (especially in intermittent 
fevers), Rhus tox., Sulphur. 



HERPES. 1035 

The Herpes prsBputialis appears from preference on the prepuce, 
but also on the scrotum, penis, and on the outer parts of the 
female organs. Its appearance in clusters of globular vesicles, 
which are soon covered with a thin crust, distinguishes it at once 
from chancre. 

Hepar or Mercur. are almost always sufficient for its removal, and 
in case of violent itching and burning in females, Calad. seguinnm. 

The Herpes Zoster, or Zona, or Shingles, is characterized by its 
peculiar way of spreading along the course of certain cutaneous 
nerves. When it appears on the thorax, the cluster of vesicles 
occupy the space in which one of the spinal nerves takes its 
course, commencing near one of the vertebrae and running 
around on one side of the trunk towards the sternum, thus form- 
ing a kind of belt around one-half of the thorax. When it ap- 
pears on the neck, it forms not only a ring around one side of 
the neck, but appears likewise upon the trunk and the upper 
arm, corresponding to the course of the cervical nerves and the 
brachial plexus. In cases where it starts from the lower lumbar 
vertebras, it spreads in a similar manner upon the thigh. Quite 
seldom is zoster found in the face, and then it occupies one-half 
of the face in the shape of a belt. Zoster is almost always pre- . 
ceded by rheumatic pains in the parts affected, by fever and de- 
bility. There is burning in the parts, then follows redness, upon 
which gradually clusters of vesicles appear, which often coalesce. 
In the course of four or six days they form into crusts. This 
terminates the attack, unless new and fresh crops of vesicles 
should break forth. The burning pain usually commences to 
leave when the eruption is fully out, and disappears entirely 
with the falling off of the crusts. Not unfrequently, however, — 
and this is quite a peculiar feature of zoster — there is developed, 
after all seems well, an intercostal neuralgia, which is very pain- 
ful and often quite obstinate. Sometimes the vesicles are con- 
verted into deep-seated pustules, leaving scars behind them ; or 
they become infiltrated with bloody serum. The duration of 
zoster is from 12, 14 to 30 days, according to the degree of the 
inflammation and the general condition of the patient. 

THERAPEUTIC HINTS. 

Arsen., severe, burning pain, worse at night, and great restless- 
ness. 

Canthar., on right side. 



1036 DERMATITIS. 

Cistus, on back. 

Comocladia, on legs. 

Crot. tigl., itching and painful burning and redness of the skin ; 
formation of vesicles and pustules; desiccation, desquamation 
and falling off of the pustules — a close picture of zoster. 

Euphorb., burning in the face; inflamed cheeks, with boring, 
gnawing and digging from gums to ears, and itching and tin- 
gling in the cheeks. 

Graphit, especially on the left side. 

Iris vers., on right side, with following gastric derangement. 

Kalm. lat, facial neuralgia after zoster. 

Laches., in spring and fall. 

Mercur. is said by some to be a specific for relieving the burn- 
ing, and preventing the appearance of new crops. Right side, 
extending across the abdomen. 

Mezer. is strongly recommended, and said to prevent and cure 
the succeeding neuralgia intercostalis. 

Pulsai, where there is gastric derangement ; evening aggrava- 
tion, and a mild, }delding, tearful disposition. 

Ranunc. bulb., preceding neuralgia intercostalis. 

Rhus tox., where there is fever, restlessness and burning-itching. 

Thuja, suppressed gonorrhoea ; burning after scratching. 

Ziucum, with lancinating pains ; suppurating herpes. 

Herpes cu'cinnatus (ring-worm) is characterized by its circular 
form. The vesicles, usually much smaller than in other forms 
of herpes, appear in the form of a circle, the centre of which is 
fading, while on the periphery the vesicles are spreading. Some- 
times, however, there is one larger vesicle, which not unfre- 
quentl}' is filled with a bloody fluid, right in the centre of the 
ring, and around the ring appears still another larger ring. 
This form is called Herpes iris, and is usually found upon the 
back of the hands or feet, on the fingers or toes, less frequently 
on the arms, thighs or face. Many forms of these eruptions 
are caused by vegetable parasites. 

THERAPEUTIC HINTS.— Compare Calc. carb., Hydrast., Xatr. 
carb., Natr. mur., Sepia, Tellur. 

3. Urticaria, Nettle-rash. 

This affection is characterized by prominent and perfectly 



URTICARIA. 1037 

smooth patches upon the skin, the color of which is either redder 
or whiter than the surrounding skin. They are formed by a 
serous infiltration of the papillary layer of the cutis. The causes 
of these eruptions are numerous. As such we may mention — 

1. Various external irritations, such as contact with nettles, or 
with some kinds of caterpillars and mollusks ; the sting of fleas, 
bed-bugs, mosquitoes, bees ; scratching with the finger-nails. 

2. Intestinal irritations from eating strawberries, crabs, clams, 
mushrooms; from taking copaiva-balsam. 3. Uterine irritations, 
during pregnancy ; menstruation ; different uterine diseases, and 
after the introduction of pessaries. 

Entirely unknown are the causes of Urticaria febrilis, which is 
chiefly attended by digestive disturbances, and has in its course 
and progress great similarity to other exanthematic fevers. I 
have often observed that symptoms which simulated croup, asthma 
or different other complaints, all at once disappeared as soon as 
nettle-rash made its appearance upon the skin. We also find 
it associated with chills and fever, and other febrile complaints. 
In some cases it assumes a chronic form, when it is quite dif- 
ficult to get rid of it. 

THERAPEUTIC HINTS.— Anac, from emotional causes. 

Ant. crud., thick, white-coated tongue ; gastric derangement. 

Apis, stinging, burning ; croupy cough ; uterine catarrh. 

Arsen., burning ; chills and fever ; alternating with croup and 
asthma. 

Bellad., during profuse menstruation; after eating cabbage or 
sour-kraut. 

Berber., heartburn, with soap-sud taste in mouth. 

Bryon., fever and rheumatic pains, worse from motion. 

Calc. carb., fat, plump children ; teething period ; chronic form ; 
rash disappears in the fresh air. 

Dalcam., itching ; after scratching, burning ; after taking cold ; 
griping pain in the bowels, with nausea and diarrhoea. 

Hepar, chronic cases; eruption on hands and fingers; during 
intermittent fever; disguised croup. 

Ignat, during the chilly stage of intermittent fevers. 

Kali carb., during menstruation ; swelling of parotid glands. 

Lycop., chronic cases. 

Pulsat, during delayed and scanty menses ; rheumatic tendency. 

Psorin., after suppressed itch, frequently repeated attacks of 



1038 DERMATITIS. 

urticaria, with fine vesicles on the top, which dry and peel off in 
fine scales; appearing regularly after any exertion. 

Rhus tox„ itching, burning; skin swollen and red; after getting 
wet; worse in the cold air; rheumatic pains, worse during rest; 
fever; thirst. 

Sepia, chronic; breaks out during a walk in the cold air and 
disappears again in the warm room ; especially on the face, arms 
and thorax; uterine troubles. 

Sulphur, chronic cases; worm symptoms; rheumatism; fre- 
quently indicated after Pulsat. 

Urtica urens, without any concomitant symptoms. 

Ustil., itching at night; ovarian irritation, with menstrual 
irregularities. 

4. Eczema, Vesicular Eruption. 

Eczema consists in a diffuse, superficial dermatitis, which cau- 
ses numerous little vesicles upon an inflamed, irregular surface; 
sometimes these vesicles are intermingled with pustules (impetigo), 
at other times the exudation may not be abundant enough to 
raise the epidermis into vesicles, but only loosens it, so that it 
dies off and forms a scaly surface ; or the epidermis is actually 
thrown off, leaving a raw, moist surface behind (intertrigo), which, 
in some cases, becomes covered with a thin scurf, in others with 
a thick crust. 

Its Causes are — 1. Direct irritation of the skin by too high a 
temperature (baker's itch); hot baths; the application of wet band- 
ages ; the rubbing in of mercurial salve or croton oil ; and by 
various other irritating substances. 

2. Stagnation of the venous blood within the capillaries. As this 
takes place most frequently on the lower extremities, we find the 
consecutive eczema there also, in the form of salt-rheum. 

3. A dyscratic diathesis of scrofulous or rhachitic individuals ; 
in overfed, plumb children. 

4. In many cases we cannot trace it to any cause. 

It chooses as favorite localities: the scalp, where it is called tinea 
furfuracea, if it causes merely a separation of the epidermis in fine 
scales; or tinea amiantacea, if the dried exudate and the loosened 
epidermis form a kind of asbest-like layer upon the inflamed 
surface. Such peeling-off processes are known under the name 
of dandruff. But it may also form thick crusts, matting the hair 
together (tinea capitis). 



ECZEMA. 1039 

When the eruption commences with vesicles and violent itch- 
ing : Rhus tox., Merc, sol., Lycop., Arsen., Crot. tigl. 

When attended with swelling of the glands of neck and nape 
of neck : Baryt. carb., Sulphur, Calc. carb., Couium. 

In rhachitic individuals : Sulphur, Silic. 

When forming out of nodes and pustules with thick crusts: 
Hepar, Calc. carb., Graphit. 

In scrofulous subjects: Baryt. carb., Calc. carb., Sulphur, Silic, 
Phosphor. (Kafka.) 

The face. Here it occurs in all forms and has received many 
different names : eczema impetiginosum, when intermingled with 
pustules; and rubrum, when growing upon an inflamed, red sur- 
face; porrigo larvalis, when forming thick crusts; tinea faciei, 
crusta lactea, when appearing during lactation; crusta serpigi- 
nosa, etc. 

The genital organs, in males the penis and scrotum, and in 
females the labia majora. It is either acute or chronic ; the lat- 
ter especially when on the scrotum. By its terrible itching it 
drives one almost to madness. It may appear also upon the 
perineum, and around the anus. 

The inner side of the thigh, just where the scrotum touches it. 
This is called eczema marginatum, and has been observed especi- 
ally in shoemakers and cavalry-men. It commences on the in- 
ner side of the thighs, just where the scrotum touches it, but 
soon appears also on the corresponding place of the other thigh. 
The legs. Here it forms a large, red, raw, constantly secreting 
surface, sometimes ulcers covered with thick crusts. This is 
called salt-rheum. When the ulcers heal, the skin appears thick- 
ened and is usually of a darker color from alteration of the pig- 
ment. 

The bends of the extremities. The scant}' exudate generally dries 
with the loosened epidermis, and forms a brittle covering which, 
on motion of the limbs, cracks in different directions. Sometimes 
the secretion is more profuse, and keeps the affected parts con- 
stantly moist. 

Hands and feet. It is a peculiar fact, that the hands and feet are 
attacked almost always simultaneously. When it appears on the 
dorsal side, it generally assumes the form of simple eczema or 
vesicles, and may be confounded with itch. On the palms of the 
hands or soles of the feet it scarcely ever occasions vesicles, but 
causes the epidermis to peel off in the form of white scales, for 



1040 DERMATITIS. 

which reason it has been called psoriasis or pityriasis palmaris or 
plantaris. It is also found on the external ears, on the eyelids, on 
the trunk, on the nipples of nursing women ("sore nipples"), on 
the navel, in the axillse, in the inguinal region of children, be- 
tween the toes in consequence of sweating. The progress of the 
disease is seldom acute ; all forms are characterized by great itch- 
ing ; scratching is apt to spread the affection further. 

THERAPEUTIC HINTS.— In selecting the remedy for such affec- 
tions, the constitutional spmptoms must never be lost sight of. 
I can give hints only to local symptoms, as the other would lead 
too far, and still could not meet all the possible complications. 

Eczema on the scalp, compare : 

Arsen., generally dry, scaly eruption, sometimes fetid, purulent 
secretion, with nightly burning or terrible itching; better from 
external warmth. 

Baryt. carb., moist crusts, with falling off of the hair; glandular 
swellings on the neck and under the lower jaw. 

Calc. carb., thick crust, moist or dry, with scrofulous diathesis. 

Clemat, the eruption inflames during the increasing, and dries 
up during the decreasing moon. 

Cicuta, with itching, or burning, or both ; the secretion from 
the vesicles forms a yellow, thick crust, which mats the hair 
together. Also on chin. (C. "Wesselhoeft.) 

Grapbit, impetiginous eruption ; soreness after scratching ; 
worse on left side, and in the evening; sticky secretion. 

Hepar, purulent secretion, itching and sore; worse in the 
morning, and on the right side; unhealthy skin, even slight 
wounds suppurate. 

Lycop., thick crusts, with fetid secretion underneath; bleeds 
easily after scratching. 

Mercur., yellow crusts, stinging, burning ; the surroundings in- 
flame easily after scratching. 

Natr. mm\, raw, inflamed surface, continually discharging a cor- 
roding fluid, which eats away the hair ; on the boundaries of 
the hair. 

Rhus tox„ thick, moist crusts; tingling, stinging, burning, espe- 
cially at night. 

Staphis.. yellow, acrid moisture oozes from under the crusts; 
upon the denuded surface new vesicles form at once which burst. 
By scratching one place the itching ceases, but appears in 
another place. 



IMPETIGO, PUSTULAR ERUPTION. 1041 

Sulphur, crusts and pimples itch spontaneously, especially at 
night ; bleed easily. 

Besides, compare Anacard., Ant. crud., Borax, Bromium, Cicuta, 
Cyclam., Dulcam., Kali bichr., Lappa, Nitr. ac, Oleander, Phos- 
phor., Sepia, Silic, Thuja, Viola trie. 

Eczema on the face, compare Arsen., Bellad., Borax, Calc. carb., 
Clemat., Cicuta, Crot. tigl., C} v lam., Dulcam., Graphit., Hepar, 
Iris, Lycop., Mercur., Mezer., Natr. mur., Rhus tox., Sarsap., Se- 
pia, Staphis., Sulphur, Viola trie. 

Eczema on the genital organs, compare Arg. nitr., Arsen., Calad., 
Crot. tigl., Graphit., Hepar, Lycop., Natr. mur., Nitr. ac, Petrol., 
Rhus tox., Sepia, Sulphur, Thuja. 

Eczema marginatum, compare Natr. mur., Sepia, Sulphur. 

Eczema on the legs, salt-rheum. As this affection is the result 
of stagnation in the venous circulation, it will be a great service 
to bandage the limbs tightly. Among the remedies compare 
Arsen., Calc. carb., Carb. veg., Graphit., Laches., Lycop., Mercur., 
Natr. mur., Pulsat., Rhus tox., Sarsap., Sepia, Silic, Sulphur. 

Eczema in the bends of the extremities, compare Amm. carb., 
Bryon., Calc. carb., Graphit., Ledum, Mercur., Sepia, Sulphur. 

Psoriasis, or pityriasis palmarum, or plantaris point to Magn. 
carb., Ran. bulb., Rhus tox., Sepia, Sulphur. 

5. Impetigo, Pustular Eruption. 

It differs from eczema only by its pyogenic tendency. As, 
however, the contents of eczema vesicles frequently become 
milky and purulent, no distinct line of demarcation can be 
drawn between these two skin affections. In fact, many of the 
eruptions cited under eczema of the scalp and face may, with 
equal propriety, be classed under impetigo. Its causes are the 
same as those of eczema. In addition, we find this form espe- 
cially in scrofulous subjects, in whom there is a great vulnera- 
bility of the skin, so that any little irritation or wound of the 
skin at once begins to fester. We also find it sometimes after 
vaccination sprouting forth over the body. 

Impetigo contagiosa. — The eruption is attended with fever; a 
part of the skin reddens, burns and itches, and now little vesico- 
pustules appear, which in five or six days reach the size of a 
split pea or a hazel nut ; they are generally umbilicated, and form 
after a while yellowish straw-colored crusts, which look as if 



1042 DERMATITIS. 

stuck on. The eruption may remain confined to the forehead and 
cheeks, but frequently extends further. The scratching with 
the nails is especialty apt to spread the affection, and it may, in 
this manner, be transmitted to other persons. 

THERAPEUTIC HINTS.— All that has been said under eczema is 
applicable here. All the constitutional symptoms must be con- 
sidered. If Hebra and his echoes assert that it be pure imagina- 
tion of an erroneous idea of the natural processes in the human 
body to suppose that eczema, if cured by external means (id est, 
by being suppressed by green soap, Kali causticum, Tar, etc.), could 
ever do any harm, we leave them to grow wiser by closer observa- 
tion, and stick to old Hahnemann and our own experience. 
There is no distinct line of demarcation between eczema and 
impetigo. The latter is admitted by Hebra himself to be in con- 
nection with a scrofulous diathesis; why not the eczema? If the 
one be the expression of a general contamination of the system, 
why not the other? But it is so much easier to cut off the fruit 
of a tree than to root out the tree itself. 

For Impetigo contagiosa, Dr. Kippax in his hand-book of skin 
diseases gives the following hints: 

Ant. crud., is the main remedy. 

Aeon., if there is much febrile disturbance. 

Euphorb., when there is an irritable skin, with swelling of the 
face, and pea-sized yellow vesicles. 

Kali bienr., stands next to Ant. crud. 

Tart, emet, when the disease is exceedingly pustular. 

Thuja, after vaccination. 

Silie. and Kali nitr., are at times indicated. 

6. Ecthyma, Isolated, Large Pustules. 

Upon a red and swollen surface single pustules appear, of the 
size of a pea, which contain a yellou; purulent, or dark-colored 
fluid, if there he blood mixed with it. They are surrounded 
by a red areola, and appear most frequently upon the extremities, 
on the seat, on the chest, and on the neck, less often on the face. 
Ecthyma is almost always attended with stinging pains, and in 
irritable persons with slight fever. In the course of a few days 
the pustules dry up and form round, brownish crusts which, 
when being removed, leave more or less extensive excoriations. 



PEMPHIGUS. 1043 

resulting in temporary scars and pigmentation. In chronic 
cases the disease is protracted by successive crops of pustules for 
a long time. 

We meet it at any time of life, and especially in consequence 
of protracted diseases, poor living, and cachectic conditions. 

THERAPEUTIC HINTS.— Compare Ant. crud., Arsen., Calc. carb., 
Cicuta, Cyclam., Kali bichr., Laches., Lycop., Merc, sol., Nitr. ac, 
Piper nigr., Secale, Silic, Sulphur, Tart. emet. 

The general constitutional indications must never be lost 
sight of. 

7. Pemphigus, Pompholyx, Isolated Large Bullae 
or Blisters. 

Upon a red, inflamed, but not infiltrated surface, pretty large 
blisters appear, which are filled with clear serum and greatly re- 
semble those occasioned by burns or fly-blisters. About their causes 
nothing is known, except that if they occur in new-born children 
they are of a syphilitic origin, and in grown persons they are 
symptoms of some general dyscrasia or cachexia. 

The acute form of this affection is extremely rare. It is always 
attended with pretty high fever, and general indisposition, and 
lasts about fourteen days. Renewed outbreaks may prolong it 
much longer. The chronic form of pemphigus, which may grow 
out of an acute attack, lasts months and even years. One crop 
after another appears upon the skin, showing the bullte in all the 
phases of their development; the youngest are transparent, the 
older have a milky appearance; they burst and leave an 
excoriated surface. This raw surface still continues to secrete 
serum, and is finally covered with a thin crust. The worst form 
is Pemphigus foliaceus. It begins with a single blister, which is 
continually increasing, until the whole surface of the body is 
literally skinned and then covered by a brownish crust. It often 
takes a fatal termination. 

THERAPEUTIC HDJTS. — Compare Arsen., Bellad., Canthar., 
Caustic, China, Dulcam., Kreosot., Laches., Mercur., Phosphor., 
Ran. bulb., Rhus tox., Sepia, Sulphur, Thuja. 



1044 DERMATITIS. 

8. Rupia or Rhypia, Isolated Blisters, which form 
thick Crusts. 

The bullse contain a purulent reddish matter, which gradually 
dries and forms a thick, dark crust. Underneath this crust matter 
continues to form, which again dries and consequently raises the 
centre of the crust, while on the periphery it becomes encircled 
by a vesicated border, which also dries up into a crust. And as 
this latter is much thinner than the first, which has been succes- 
sively heaped up, the whole assumes a great similarity to an oyster- 
shell. On removing the crust we find a deep, foul, excoriating 
ulcer. Rupia is a late and malignant manifestation of syphilis. 

THERAPEUTIC HINTS.— Compare Syphilis.— Berjeau gives the 
following hints: 

Clemat, growing worse during the increasing moon ; discharge 
of a sanious pus, yellow and corrosive; burning and tingling in 
the ulcer; itching worse at night in bed. 

Mercur., violent itching, worse in bed; ulcerating pimples; 
desquamation of the skin ; excoriations of a tettery nature, which 
are oozing constantly and bleed easily when scratched. 

Mtr. ac, after mercury; copper-colored spots; watery, bloody 
secretion. 

Sarsap., also after the abuse of mercury; purulent vesicles, itch- 
ing ; depression of spirits. Especially in the spring. 

Sulphur, scabious eruptions with burning itching, surrounded 
by a yellow or brownish areola; secretion of a sanious, fetid or 
thick and yellow pus; spots covered with small vesicles, dis- 
charging serous lymph. 

Thuja, brown or red mottled spots, with itching shootings in 
the evening: purulent pimples, containing fluid-like varnish. 

9. Furunculus, Boil. 

A furuncle commences as an inflammation of one or several 
closely-grouped cutaneous glands, or hair-follicles, which become 
infiltrated. By-and-by the inflammation spreads to the surround- 
ing cellular tissue, and through the entire skin, suppuration takes 
place, and, accompanied by acute pains, and at times fever, the 
boil breaks and discharges a bloody matter; the core (which 
consists of destroyed cellular tissue), however, is not discharged 



CARBUNCULUS. ] I ) i." 

until all of it has been loosened from its surroundings. Large boils 
generally occur singly; small ones, so-called blind boils, which 
discharge very little, or nothing at all, frequently appear in crops, 
or in rapid succession, and may torture a patient for a consider- 
able length of time. Their exact cause is unknown, but they seem 
to depend upon some depraved state of the blood in the general 
system, they frequently appear during the reconvalescence from 
severe illness, and at times as epidemics. 

THERAPEUTIC HINTS.— Never use the lancet nor allow it to 
be used, because it never does any good, but always harm, as 
it increases the inflammation and protracts the healing process. 

For large boils, compare Apis, CrotaL, Hepar, Laches., Lycop., 
Mercur., Nitr. ac, Silic, Stramon. 

For small ones, Arnica, Bellad., Niix vom., Sulphur. 

For a disposition to boils, Arsen., Calc. carb., Lycop., Nux vom., 
Phosph. ac, Plumbum, Silic, and Sulphur. 

10. Carbunculus, Carbuncle. 

The carbuncle is a phlegmonous dermatitis, and commences 
with severe pains in the part affected, which are mostly of a 
burning character, and continue to be so through the whole 
course. The painful spot commences to swell, to harden, to dis- 
color; it generally assumes a purplish hue. After five or six 
days numerous little holes form in the swollen and discolored 
place, from which a yellowish mattery substance projects. The 
swelling and hardness still continue to increase in circumfer- 
ence. Only a little pus is discharged from the small holes. 
They, however, gradually widen and coalesce, until by degrees 
a considerable portion of the cutis is entirely destroyed; or the 
epidermis is raised in the form of a gangrenous blister, which 
finally breaks. We now observe the necrosed cellular tissue un- 
derneath; the pus discharges more copiously, and with it large 
pieces of destroyed tissue slough off. The loss of substance some- 
times amounts to several square inches. This process is always 
attended with considerable fever, and is quite apt to assume an 
adynamic character. When complicated with cerebral symp- 
toms, which are the consequence of the absorption of the pus 
by the blood, it may terminate fatally. In favorable cases 
new granulations appear at the bottom of the wound, and 



1046 DERMATITIS. 

by a slow healing process the whole lost substance is finally re- 
stored. 

Carbuncle differs entirely from furuncle. It is of a much more 
destructive character, appears principally on the nape of the 
neck, or along the spine, on the forehead, or buttocks, and chiefly 
attacks aged persons, while furuncle is never associated with 
gangrenous destruction of substance, it appears here and there 
and everywhere, and attacks all ages alike. 

THERAPEUTIC HINTS.— No knife. But compare: 

Anthrac., when the burning pain is violent and not relieved by 
Arsen.; cerebral symptoms; absorption of pus by the blood; 
gangrenous destruction. A carbuncle on the back of a man, 
some sixty years of age, had attained the size of nine inches in 
length, and five inches in its greatest width. There was slough- 
ing, abundant discharge of ichorous, terribly smelling pus, and 
poisoning of the blood by absorption of pus. Arsen. had no 
beneficial effect ; Anthrac. relieved at once. Ever since then I 
have given Anthrac. in several cases, where there were symptoms 
of the same destructive character, with the same beneficial result. 

Apis, when the erysipelatous inflammation extends further 
and further. 

Arsen., great burning; great restlessness; great thirst, drink- 
ing but little at a time; great debility; all the symptoms are 
worse in the night, and better from external warm applications. 

Bellad., bright redness; throbbing pain; drowsiness, with ina- 
bility to go to sleep. 

Carb. veg., dark, blackish appearance; fetid odor; hippocratic 
face. 

Kreosot. 

Laches., bluish, purplish appearance; inability to bear any 
bandage around the neck ; cerebral symptoms. 

Nitr. ac. 

Rhus tox., great restlessness; feels somewhat relieved of the 
violent pain as long as he is in motion. 

Secale, cannot bear external warmth. 

Silic, during the process of ulceration; it seems to clear the 
wound of its decayed masses, and to promote healthy granulation. 



PUSTULA MALIGNA. 1047 

11. Pustula Maligna, Malignant Pustule, 

also called Carbunculus contagiosus, is characterized by the appear- 
ance of an angry-looking pustule, associated with gangrenous 
destruction of the surrounding parts, which owes its origin either 
to a direct inoculation of the poison from an animal affected 
with the disease called Anthrax, Milzbrand or Charbon, or to a 
transmission of the poison by flies, or to inoculation of the 
poison from man to man, or to the eating of the flesh of diseased 
animals. It is therefore most frequently found among persons 
who have to do with diseased animals, or who work in manufac- 
turing establishments, where the products of such animals (hides, 
horsehair, wool) are prepared for different uses. The infection 
takes place principally on the uncovered parts of the body which 
are exposed to the entrance of the poison. The eating of diseased 
flesh first causes general malaise and intestinal troubles, after 
which, in about eight or ten days, anthrax carbuncles appear, by 
preference on the arm, forearm and head. 

After an incubation of from a few hours to several days, there 
is at first felt on the spot where the poison took hold, a slight 
burning and itching, as if from the bite of an insect, and one 
can see a little red speck with a black point in its centre. This 
soon becomes changed into an itching papule, capped with a 
small, generally reddish or bluish vesicle, which gradually en- 
larges. After bursting it discloses a dark red base, which becomes 
covered with a crust, while often, though not always, secondary 
vesicles spring up around it, which contain a yellowish, reddish 
or blackish fluid. At the same time the surrounding parts swell 
cedematously over a considerable area, the cellular tissue under- 
neath also becomes infiltrated, and in many cases discolored lines 
mark the course of the veins, or red stripes the course of the 
lymphatic vessels in the cedematous region ; the corresponding 
lymphatic glands also swell. The general symptoms correspond 
with the severity of the local affection ; there is fever, great 
weakness, delirium, excitement, confusion; sweating, diarrhoea 
and pain in the extremities ; in fatal cases collapse ; in favorable 
cases after the dead masses have been removed by sloughing off, 
the wound gradually heals by healthy granulation. 

THERAPEUTIC HINTS. 

Laches., bluish color of the pustule, and red streaks along the 
lymphatic vessels. (Dunham.) 



1048 DERMATITIS. 

Anthrac., blood-poisoning. 

Malandrinum, blackish diarrhoea ; pain in back and limbs ; pus- 
tule similar to a badly-looking vaccine-pustule. (R. Straube.) 
Compare Carbuncle. 

12. Epithelioma, Epithelial Cancer. 

It usually begins as a little tubercle, or flat infiltration, which 
sooner or later cracks and ulcerates, forming a roundish sore 
with indurated edges, and a thin scanty secretion, that 
sometimes covers the ulcer with a brownish or yellowish crust. 
At an advanced stage the edges become undermined and bleed 
easily, the base assumes a dirty or grayish, more or less papil- 
lated aspect, secreting an offensive, pale, yellowish, viscid fluid. 
At other times the epithelioma develops in the form of warts or 
cauliflower excrescences of various sizes, which ultimately break 
down and form irregularly shaped ulcerating excavations which 
bleed easily. The first or roundish form infects by preference 
the lower lip ; if occurring on the upper two-thirds of the face, it 
constitutes the rodent ulcer of English writers, and when origi- 
nating on the scrotum, it is termed Chimney sweeper's cancer. It 
is, however, also found on the tongue and mucous membrane of 
the cheeks, and may appear on any part of the body. The sec- 
ond form, of cauliflower appearance, attacks by preference the 
vulva, clitoris, penis and rectum, and might be mistaken for a 
syphilitic affection if it were not for the history of the case. 

The course of epithelial cancer is sometimes slow, sometimes 
rapid. It sooner or later involves the lymphatic glands, is at- 
tended by sharp, lancinating pains, and if left alone destroys life, 
by exhaustion, in from two to five years. 

THERAPEUTIC HTNTS.— The main remedies seem to be: Arsen., 
Calc. oxal., Hydrast., Phytol., Sepia, and Thuja. An external ap- 
plication of the well-chosen remedy at the same time will often 
be of great service. 

13. Panaritium, Paronychia, Whitlow, Run-Around, 
Felon. 

It is an inflammation of the thumb or of one of the fingers, 
which terminates in suppuration. There are two distinct varie- 
ties of this inflammation, a superficial and a deep-seated one. 



PANARITIUM, PARONYCHIA, WHITLOW. 1049 

The superficial form, Whitlow, Run-Around, is generally seated 
immediately around and beneath the nail, commencing either at 
the side of the finger, upon its dorsal surface, or at its extremity. 
Without much, if any swelling, the part is of a dusky reddish 
aspect, tender on pressure, and exquisitely painful, throbbing 
violently and incessantly, and causing more or less constitutional 
disorder. Two or three days after these phenomena present 
themselves, matter is observed beneath the epidermis, which 
is elevated into a yellowish vesicle at the side and root of 
the nail. In many cases pus is also situated beneath the nail, 
especially at its posterior extremity; and sometimes, again, it 
is found chiefly, if not exclusively, in the cellular substance, 
immediately beneath the true skin. The inflammation gen- 
erally extends some distance up the finger, and occasionally 
even over a considerable portion of the hand, which may be 
considerably swollen, stiff and painful. Not unfrequently a red- 
dish line, indicating the course of an absorbent vessel, is seen run- 
ning along the limb, as high up, perhaps, as the axilla. 

In the deep-seated variety, Felon, the inflammation involves all 
or nearly all the structures of the finger, and is frequently fol- 
lowed by the destruction of one or more of the phalanges. The 
pain is of extraordinary severity, depriving the patient of sleep 
for days and nights together, throbbing, tensive and diffused, 
often extending as high as the elbow, and even to the shoulder, 
steady and persistent, but greatly aggravated by a depending 
position, and only subsiding with evacuation of the inflam- 
matory deposits, or the death of the parts. The swelling also 
is great, sometimes enormous, involving both finger, hand and 
wrist; the skin is red and cedematous, puffy, erysipelatous in 
aspect, and the whole limb is often stiff and useless. In con- 
sequence of the inflammatory action, pus forms deep among 
the tissues, in the connecting cellular substance, within the 
sheaths of the tendons, and beneath the periosteum; and spread- 
ing in all directions, causes extensive destruction, burrowing 
along the finger and hand. In neglected cases even gangrene 
may occur, followed by sloughing of the tendons, and exfoliation 
of the phalanges. This grave form is always attended with well- 
marked constitutional disturbance. The patient, tortured with 
pain, is feverish and unable to sleep; his appetite is lost; his 
head, back, and limbs ache; the face is flushed, and the pulse is 
strong, hard and frequent. In some cases delirium is present. 
(Gross.) Causes unknown; no doubt of a psoric nature. 



1050 DERMATITIS. 

THERAPEUTIC HINTS.— Amm. carb. I have seen the nightly pain 
which had deprived the patient of sleep for several nights, re- 
lieved in a few hours, and the morbid process staid at the same 
time by one or two doses of Amm. carb. 500 

Antlirac., where there is sloughing, with terrible burning, and 
when Arsen. gives no relief. 

Apis, according to Wolf, specific especially after the abuse of 
Sulphur ; the characteristic pain is burning-stinging. 

Arsen., when the sore assumes a gangrenous aspect; burning 
like fire, with anxious restlessness; worse about midnight. 

Bryon., in the commencement, where there is a gastric-rheumatic 
disposition; white or yellowish-coated tongue; dry .feeling in the 
mouth, without thirst, or great thirst; bitter taste in the mouth; 
dry, hard stool, as if burnt. 

Caustic, recommended by Goullon, to be used externally and 
internally. 

Graphit, according to Kreussler, superficial inflammation about 
the root of the nail, with burning and throbbing pain, and sub- 
sequent inflammation and proud-flesh. 

Hepar, violent, throbbing, "gathering" pain; it accelerates sup- 
puration. 

Juncus eff., recommended by Minnichreiter, who applied the 
pith of this plant upon the panaritium with the greatest success. 

Laches., according to Hering, in severe cases, where the in- 
flamed portion assumes a purplish hue, or becomes gangrenous. 

Ledum, when the whitlow is the consequence of the prick of a 
needle, a splinter, etc. 

Lycop., when there are the following constitutional disturb- 
ances : frequent belching, bloatedness of the region of the stom- 
ach and belly; pressure and heaviness, and sometimes throbbing 
in the precordial region ; burning in the stomach and oesopha- 
gus ; nausea ; sensation of twisting, crawling and emptiness in 
the stomach, accompanied by frequent yawning; congestion to 
the head ; cold feet ; dry stool ; red, burning urine ; mental irri- 
tability. 

Maland., suppuration of all the finger and toe-nails. (Straube.) 

Mercur., when the inflammation extends to the sheaths of the 
tendons and ligaments of the joints, and in superficial whitlows. 

Natr. sulph., suppuration at the root of the nail, with deep-red 
swelling of the whole phalanx, and great painfulness ; the pa- 
tient looks sickly and pale; feels weary and dull in the head, 




PSORIASIS. 1051 

especially in the morning; has no appetite, and is chilly and 
feverish in the evening; the pain is easier out-of-doors than in- 
doors. Prominent causes: damp region, damp walls, damp cel- 
lars. 

Rhus tox., where there are rheumatic pains in the limbs; 
worse during rest and on beginning to move ; sensation in the 
limbs as of going to sleep, and formication ; tired feeling, and sweat- 
ing from any little exertion; erysipelatous redness of the in- 
flamed part. 

Sanguin., suppuration of the roots of all the finger-nails. 

Silic, deep-seated inflammation; affection of the bone; proud 
flesh; terrible pain; worse in bed; very important after Hepar. 

Stramon., is most important when the pain is almost unbeara- 
ble, driving to despair. It ameliorates it at once, and hastens 
benign suppuration. 

Sulphur, according to Wolf, when Apis is not sufficient on ac- 
count of latent psora. 

14. Psoriasis. 

It consists in a chronic dermatitis, with infiltration of the 
corium and a morbid condition of the epidermis. The effusion 
upon the corium is not abundant enough to raise the epidermis 
into vesicles. It causes a mere hyperemia of the skin, in conse- 
quence of which the papillary layer produces a sickly epidermis, 
which soon loosens and drops off in scales. Its causes are quite 
obscure. In some families it is hereditary. Quite young child- 
ren, and quite old persons are seldom attacked by it. This af- 
fection commences in small, red, somewhat elevated, roundish 
spots, like drops, which are soon covered with dry, oblong, white 
scales— Psoriasis guttata. When the spots increase in number, 
they necessarily coalesce as they grow, and form large irregular 
surfaces, which are covered with scales of various thickness and 
adhesiveness — Psoriasis diffusa of Wittan. They sometimes ac- 
cumulate in round patches. While on the periphery new spots still 
appear, those in the centre dry up, and this gives rise to a circu- 
lar eruption — Psoriasis annulata (ring-worms). Or, several of such 
circles meet, their peripheric lines are broken off by already 
healed up centres, and now they form various figures, parts of 
circles, straight lines, etc. — Psoriasis gyrata. In some cases this 
morbid process continues for a long time, and causes the skin to 



1052 DERMATITIS. 

become thickened, rigid and cracked. This takes place especially 
in the diffuse and irregular forms ; then it is called Psoriasis 
inveterata. These^ different names are not to be understood as in- 
dicating different varieties, but forms and stages of the same cu- 
taneous affection. The favorite places for psoriasis are the ex- 
tensor sides of the extremities, especially the knee and elbow. 
In many cases the disease is confined to these localities. Fre- 
quently it appears symmetrically on both sides of the body, simi- 
lar to eczema. Sometimes it is found on the eyelids, lips, pre- 
puce, scrotum and labia majora. The so-called Psoriasis palmaris 
and plantaris, by which the redness and infiltrated surfaces of 
the palms of the hands and of the soles of the feet are covered 
with dry scales, belongs to eczema, and its eircumscript form is 
always of a syphilitic origin. 

THERAPEUTIC HINTS.— Compare Arsen., Calc. carb., Clemat., 
Corall., Cuprum, Fluor, ac, Hydroc, Iris vers., Mercur., Xitr. 
ac, Petrol., Phosphor., Phosph. ac, Phytol., Psorin., Selen., Sepia, 
Silic, Sulphur, Tellur. 



15. Lichen. 

One form, Lichen simplex, consists of little red papules, of the 
size of a millet seed, usually appearing on the outer parts of the 
forearm, sometimes on the back of the hands, on the neck and 
thigh. Thej 7 appear mostly in summer time and are accom- 
panied by itching. 

The other form, Lichen planus, consists of dull red, flat-topped 
papules of the size of a millet seed, at first of a shiny appearance, 
but later covered with thin scales; their centre presents an uni- 
bilicated depression, the opening of a hair-follicle, and after 
thei* disappearance they leave at times a darkish stain or a little 
pit. They appear singly and in groups, and are found especially 
on the forearms, wrists, thighs, abdomen, and legs below the 
knees. The Lichen ruber of Hebra is commonly associated with 
marasmus. 

THERAPEUTIC HLNTS. 

For Lichen simplex Kippax recommends: Alum., Amm. mur., 
Anather., Ant. crud., Arsen., Bellad., Bovista, Bryon, Castanea 
vesca, Calad., Iod. of sulphur, Kreosot., Ledum, Mercur., Xabulus 



PRUKIGO, PRURITUS. 1053 

serp., Natr. carb., Nux jugl., Plant, maj., Phytol,, Rumex, Sepia, 
Sulphur., Tilia. 

For Lichen planus: Ant. crud., Agar., Arsen., Chin, ars., Iodium, 
Iod. of sulphur, Kali bichr., Ledum, Nux jugl., Potass, iod., Sarsap., 
Staphis. 

16. Prurigo, Pruritus. 

Instead of conical pimples, as found in lichen, prurigo exhibits 
flat papules, which have the same color as the surrounding skin. 
When broken they discharge a small drop of a clear fluid, and 
are attended with an intolerable itching. Want of personal 
cleanliness, of the proper change of clothing, and poor and un- 
wholesome food are probably its most frequent causes. Hebra 
asserts that it is found only in the poorer classes of the people. 
With the exception of the first years of childhood it is found in 
all ages, and more frequently in men than in women. The flat 
papules, which at first appear singly, and which ma}^ even be 
difficult to detect by sight, as they do not differ in color from the 
surrounding skin, cause a most terrible itching, which incites 
the person to scratch. Hereby the papules become denuded of 
their epidermis; they bleed, and the exuding blood forms dark 
crusts upon the scratched localities. Thus, it closely resembles 
in appearance the torn surface from scratching, in consequence of 
itch or lice. Prurigo, however, has favorite localities, differing 
from either itch or lice. While the acarus prefers to locate be- 
tween the fingers, in the bends of the limbs, and on the belly, 
and lice take their abode in preference where the shirt lies in 
folds, on the neck, around the waist, etc., prurigo is found prin- 
cipally on the extensor sides, especially of the lower limbs and 
on the back; a feature decidedly distinguishing prurigo from 
itch. The finding of the acarus or of lice would settle the ques- 
tion. But even then there might be a complication between pru- 
rigo and itch. The spotted appearance of the skin is nothing 
but the necessary consequence of the violent and continued 
scratching. The skin being continually torn, simple crusts 
not only form, but the surface commences to fester and to 
cicatrize. 

Milder cases of prurigo, where the disease is confined to the 
lower extremities, are called prurigo mitis; graver cases are called 
prurigo formicans. Those which are confined to the anus, penis, 
scrotum or vulva, prurigo pudendorum, are related to eczema. 



1054 DERMATITIS. 

The disease has its remission during spring and summer and 
its exacerbations during fall and winter. 

The effects of prurigo upon the general organism grow the 
more apparent the longer the disease lasts. The constant unbear- 
able itching, which destroys all comfort, rest and sleep, wears the 
patient out, and has led some to utter despair and suicide. There 
is also combined with this disease a remarkable tendency to 
rapid, serous exudations into the serous membranes of the brain 
and lungs, a tendency to aberrations of the mind and to tuber- 
culosis. 

Pruritus is a hyperesthesia of the cutaneous nerves, frequently 
a reflex symptom, without any eruption, or an itching of the 
skin in consequence of some foreign material, like bile, coursing 
in the blood and irritating the cutaneous nerves, as in jaundice. 

THERAPEUTIC HINTS.— Arsen., Calc. carb., Carb. veg., Dolichos 
prur., Graphit., Iodium, Lycop., Mercur., Mezer., Xitr. ac, Rumex 
crisp, (the itching is made worse by cold and better by warmth 
— H. Bernard-Hardenpont), Sepia, Sulphur. 

The pruritus of pregnant women has been relieved by the 
smoking of a cigar. 

17. Scabies, Itch. 

Itch, namely, acarus-itch, is a dermatitis, which is caused by a 
parasite, called acarus scabiei seu sarcoptes hominis. This insect 
burrows itself into the skin in order to find shelter and to deposit 
its eggs. This causes the inflammation, which produces papules, 
vesicles and pustules. It is always attended with great itch- 
ing, especially at night, when these animals are the liveliest, 
leave their holes and pay each other visits. One pregnant fe- 
male acarus, if it be transplanted to anotber person, is sufficient 
to invest this person with the itch. Her eggs ripen in about 
eight or ten days ; the j-oungsters creep out and do exactly as the 
old ones did ; the mischief is done. Infection takes place, there- 
fore, most readily if one happens to sleep with another who has 
the itch ; but also by shaking of hands, by clothing, by using the 
same towel, etc., the female acarus may be transplanted. The 
fact makes itself known first by an intolerable itching on those 
parts, which the acarus seems decidedly to prefer, namely the 
hands, especially between the fingers, the cleft of the nates, the 



SCABIES, ITCH. 1055 

bends of the extremities, the abdomen, and the genital organs, 
never the face. It seems that this terrible itching is caused not 
only by the action of the insect in burrowing itself into the skin, 
but also by an acrid juice, which it probably secretes. The 
objective signs which now follow are the above mentioned pim- 
ples, vesicles and pustules, on account of which the books speak 
of a scabies papulosa, vesiculosa and pustulosa. The most charac- 
teristic signs of acarus-itch are, however, the little furrows which 
are dug by the insects. They present dotted, irregular streaks, 
which have a great similarity to little scratches of a needle. At 
their commencement there is generally a vesicle, seldom a papule or 
pustule ; at their end, a little way from the vesicle, the insect sits, 
appearing as a whitish speck. By carefully entering this small 
channel with a fine needle the perpetrator may be pierced and 
extracted. 

Itch never heals spontaneously, and the more the insects mul- 
tiply, the worse it grows. The original irritation caused by the 
insects, and the additional one by scratching, causes the whole 
eruption to assume the form of eczema and impetigo, with vesi- 
cles, pustules and crusts of different sizes. 

GENERAL THERAPEUTIC REMARKS.— The old school consid- 
ered it a great triumph when, in the year 1834, by M. Renucci, 
a young Corsican in Paris, who had learned in his native island 
the art of extracting the little animal, the question about the 
nature of itch seemed to be settled. Hahnemann's psora-theory 
had thus been exploded by a needle in a Corsican's hand, and 
with it, all Homoeopathy ! They simply forgot, in their heart's 
delight, that before that time many other cutaneous eruptions 
were considered as itch ; amongst them, as Hebra himself sup- 
poses, prurigo, with its undoubted metastases to inner organs. 
If we now take a glance over Hahnemann's masterly picture of 
what he calls psora, we shall at once perceive that, under psora, 
he did not understand acarus-itch solely, but gave a tout en- 
semble of chronic cutaneous affections in general. The child 
had to have a name, and psora was as good a name as eczema, 
impetigo, prurigo, or any other. Thus the needle, although 
it found the acarus, altogether missed Hahnemann's psora. It 
is just as true to-day that a suppression of cutaneous eruptions, 
of various kinds, will be followed by disastrous consequences 
upon the general system, as it was true when Hahnemann and 
others observed it. Instead, then, of desiring to have Hahne- 



1056 DERMATITIS. 

m aim's psora theory wiped out of the pages of Homoeopathy as a 
disgraceful spot, we ought to be proud of our old master's keen 
observations. But then we must understand him rightly. I ad- 
mit that, in recent cases of acarus-itch, the killing of the animal 
is the shortest procedure to cure, without detrimental effects 
upon the organism. This end may be attained not only by the 
external application of sulphur and mercurial salves, but also by 
peruvian balsam or the twigs of the balsam poplar tree, populus bal- 
samifera (L.), Tacamahac (Ind.), which secretes a kind of resinous 
substance on the pedicles of its leaves and around its twigs. But 
as it is an undoubted fact that itch never heals .spontaneously, and 
as we have likewise undoubted facts that it has been cured 
solely by the internal application of homoeopathic remedies, it 
seems that those who contend that even acarus-itch in the course 
of time is not altogether a mere local, cutaneous trouble, are after 
all deserving some credit. All parasites, no matter whether 
animal or vegetable, can grow only upon a suitable soil ; if this 
soil be made insupportable to them, they die or leave, and this 
is as good as killing, regarding the riddance of the intruders, 
but it is infinitely better for the patient, as by this means the or- 
ganism is not injured, but brought into a healthy state. 

SPECIAL HINTS. — Arsen., inveterate cases; eruption in the 
bends of the knees ; pustulous eruption ; burning and itching ; 
better from external warmth. 

Carb. veg., eruption dry and fine, almost over the whole body, 
worst on the extremities; itching worst after undressing; dys- 
peptic symptoms ; belching of wind and passing flatus ; after the 
abuse of mercurial salves. 

Caustic, after the abuse of sulphur and mercury; yellowish 
color of the face; warts on the face; involuntary discharge of 
urine when coughing, sneezing or walking ; sensitiveness to the 
cold air. 

Hepar, fat, pustulous and crusty itch ; also after previous abuse 
of mercury. 

Mercur., fat itch, especially in the bends of the elbows. 

Psoriii., inveterate cases; with symptoms of tuberculosis; also 
in recent cases ; eruption in the bends of the elbows and around 
the wrists ; repeated outbreaks of single pustules, after the main 
eruption seems all gone. 

Sepia, after previous abuse of sulphur; itching worse in the 
evening ; especially in females. 



PRAIRIE ITCH. 1057 

Sulphur, main remedy; voluptuous tingling-itching, with burn- 
ing and soreness after scratching. 

Sulph. ac, when itchiness of the skin and single pustules ap- 
pear every spring, after an imperfectly cured itch. 

18. Prairie Itch, Prurigo Contagiosa, 

"Is an acute inflammation of the skin, appearing in new dis- 
tricts, where it may be for a time endemic. It may be preceded 
by the premonitory symptoms of malaise, headache and slight 
febrile disturbance; or its onset may be first marked by the ap- 
pearance of erythematous points, covered with small transparent 
vesicles, varying in size from a pin's head to a mustard seed, and 
situated for the most part on the neck, shoulders, back and outer 
surface of the limbs. An intolerable nightly itching accompa- 
nies the eruption, creating an almost irresistible desire to scratch 
the parts. The scratching obliterates the vesicles, and gives rise 
to scratch-marks, and to the secretion of an exceedingly acrid, 
irritating fluid, which oftentimes indefinitely prolongs the dis- 
ease. Large blackish crusts covering suppurating ulcers are an 
occasional result. Furuncles quite frequently complicate the 
trouble." (Kippax.) 

THERAPEUTIC HINTS.— Rumex crisp., principal remedy. (Searle.) 
Diluted lye-of-wood ashes locally. 
Rhus tox. and Ledum may be studied. (Kippax.) 

V. ANOMALIES IN THE SECRETIONS OF THE 
SKIN. 

The secretion of gaseous substances is either augmented, for ex- 
ample, in fevers, when the temperature of the body is consider- 
ably raised, and in a hot atmosphere; or it is diminished, when 
the air is damp and its temperature low. In disease, a diminu- 
tion of gaseous secretion has been ascertained by actual measure- 
ment only in diabetes mellitus. 

The secretion of watery substances, which is called perspiration 
or sweat, may be promoted in any healthy person by drinking 
large quantities of water, and covering with a thick blanket, by 
strong exercise of the body, by the heat of the weather, etc. In 
disease it is sometimes entirely wanting, at other times, a very 
67 



1058 ANOMALIES. 

prominent symptom, for example, in pneumonia, in some forms 
of rheumatismus acutus, etc. Some persons are much more in- 
clined to sweat than others ; an excessive inclination to sweat is 
called Hyperidrosis. It seems that repeated sweatings increase the 
inclination to it. When the fluid which is secreted in the sudo- 
rific glands cannot pass freely upon the surface, either because 
the sudorific ducts are stopped up, or because they are too nar- 
row to give vent to all the fluid which is produced within the 
glands, we observe the fluid to collect under the epidermis, and 
to raise it into numerous little vesicles, which contain a perfectly 
transparent fluid of an acrid reaction. This eruption is called 

Sudamina, or Miliary Rash. 

The stoppage of the outlets of the sudorific glands occurs most 
frequently in diseases in which there has been great dryness of 
the skin previous to the outbreak of the sweat, as, for example, 
in the first weeks of typhus. The appearance of the eruption 
has no influence upon the course of the disease; it is observed as 
well in critical sweats as in those which break out sometimes 
when the disease takes a bad turn and may even appear during 
the last struggles of agony. When the transparent, minute vesi- 
cles appear upon a naturally-colored skin, it is called miliaria 
alba, when upon a skin which is reddened by hypera?mia or 
hsemorrhagic effusions, it is called miliaria rubra. As a symp- 
tom, it may indicate Arsen., Bryon., Calc. carb., or Ipec. 

Prickly heat is likewise a miliary rash, consisting of numerous 
pin-head-sized, reddened papules, or vesico-papules, in conse- 
quence of a disordered action of the sweat-glands, covering the 
trunk, arms, neck and even, at times, the face. It occurs during 
the hot weather, and is often very annoying on account of its 
stinging-itching, but usually disappears when cooler weather sets 
in. 

Quite frequently do we find partial hyperidrosis on the palms 
of the hands, on the soles of the feet, under the arm-pits and on 
the genitals. The sweat of the feet, in the axilla? and on the 
genitals, is often excessively offensive, which seems to have its 
cause in a decomposition which the sweat, the sebaceous secre- 
tion and the softened and loosened epidermis undergo. The 
suppression of these partial sweats has been considered from 
olden times as ver}* detrimental to health, causing spinal affec- 



SUDAMINA. 1059 

tions and different other complaints. In later times this has 
been reversed; now they say: intercurring diseases stop this par- 
tial sweating. May be, may be not. So much is certain, and I 
have observed many a time that the cessation of partial sweats 
stands in closest relation with various general complaints, and 
that the patient does not get better until the general foot-sweat 
or axilla-sweat, etc., is re-established. 

THERAPEUTIC HINTS.— Compare any Repertory. 

Suppressed foot-sweats indicate especially Apis, Cuprum, Nitr. 
ac, Pulsat., Sepia, Silic. 

A diminution of fluid secretion, causing great dryness of the 
skin, often attends marasmus senilis. Sometimes it is a dis- 
turbed innervation, and sometimes the consequence of skin dis- 
eases. Besides, there are cases of Anidrosis and even of half-sided 
anidrosis, for which there is no explanation. 

A qualitative change in the secretion of sweat takes place in 
icterus, which colors the linen yellow, and in suppressed urinary 
secretions, when the sweat contains urinary ingredients. 

The secretion of sebaceous substances, if diminished, causes great 
dryness and brittleness of the skin ; if augmented (seborrhcea), it 
forms crusts upon the scalp, especially in children, or on the 
cheeks, nose, eyelids, ears and nipples, especially in females who 
menstruate irregularly. A thickening of it within the excretory 
ducts causes comedones, milium and atheromata. 

A Comedo has a dark surface from the dust and dirt outside, 
which has been mixed with it. 

A Milium is a collection of hardened sebum within the extended 
follicle; being covered by the epidermis it shows no dark, dirty 
point. 

A Molluscum is a greatly enlarged sebaceous gland, which is 
filled by thickened sebum. Being always united with a hair- 
follicle, with which it has a common outlet, the swelling or tumor 
generally shows a dark point and umbilical depression on its 
summit. The color of the skin over it is either normal in color 
or pinkish. It attacks mostly the face, but it may appear on 
other parts. Its contents can often be squeezed out. 

Internal remedies are: Silic, Calc. ars., Bryon., Kali hydr., 
Lycop., Natr. mur. 



INDEX. 



Abdomen, 469 
Abdominal breathing, 341 
Abnormal largeness of head, 114 

smallness of head, lib" 
Abortive typhoid, 981 
Abscess of ankle-joint, 849 

of bladder, 681 

of brain, 76 

of cornea, 153 

of lid, 132 

peritonsillar, 278 

renal, 673 

retro-pharyngeal, 2S7 

retro-tonsillar, 278 
Acarus scabiei, 1054 
Accommodation, 172 
Achroma, 1032 
Acne punctata, 241 

rosacea, 241 
Acute tumor of spleen, 629 

yellow atrophy, 603 
Adaptation, 173 
Addison's disease, 678 
Affections of bronchial tubes, 365 

of pleura, 415 

of pulmonary parenchyma, 3S5 
Aegophonv, 364 
Agraphia, 89 
Ague, 947 
Akinesia, 908 
Albumen in urine, 639 
Albuminuria, 656 
Alcoholism, chronic, 106 
Alcohol tremor, 906 
Alopecia, 129, 1032 

syphilitic, 718 
Alterations of nails, syphilitic, 71S 
Amaurosis, 167 
Amblyopia, 167 
Amenorrhcea, 778 
Amygdalitis, 278 
Amyloid degeneration of kidneys, 671 

liver, 606 
Analogy between ear and eye, 188 
Anatomical peculiarities of spleen, 627 
Anchylops, 132, 135 
Anchvlostomum duodenale, 576 



Anaemia, 927 

of brain, 33 

pernicious, 928 

of the skin, 1032 

of spine, 793 
Anaesthesia, 853, 873 

of larynx, 334 

of soft palate, 281 

of the trigeminus, S74 
Aneurisms in brain, 112 
Aneurism of thoracic aorta, 464 
Angina catarrhalis, 2S1 

faucium, 281 

follicularis, 2S3 

Granulosa, 283 

Ludovici, 288 

maligna, 1011 

pectoris, 461 

tonsillaris, 278 
Anidrosis, 1059 
Annulns cartilaginus, 192 

tympanicus, 192 
Anomalies in the secretion of the skin, 

1057 
Anteflexion of womb, 757 
Anteversion of womb, 757 
Anthrax, 1047 
Aphasia, 89 
Aphonia, 335 
Aphthae, 292 

Apoplexy pulmonum, 412 
Apoplexia pulmonum vascularis, 410 

sanguinea, SI 
Apoplexy of spine, 794 
Appearance of urine, 634 
Appendix vermiformis, inflammation of, 

507 
Armed tape-worm, 572 
Arthritis, 831 

deformans, 

sicca, 

spuria, nodosa, pauperum, 

rheumatoides, 834 
A rthrocerosis, 834 
Articuli dnplicati, 835 
Ascaris lumbricoides, 570 
Ascites, 588 



1062 



Aspect of face, 235 
Aspermatism, 735 
Asthenopia, 177 

Asthma bronchiale nervosum seu eonvul- 
sivum, 380 

laryngeum infantum, 336 

Millari, 336 

spasmodicum, 336 

thymicum Koppii, 336 
Astigmatism, 176 
Atheromata, 1059 
Atony of bladder, 689 
Atropine spinal paralysis, 816 
Atrophy, muscular, progressive, 838 

of brain, 95 

granular, of kidney, 667 

of the nerves, 852 

of the skin, 1032 

of skull, 117 
Auscultation of chest, 351 

of cough, 364 

of heart, 430 

of larynx, 314 

of voice, 360 
Auditory canal, 191 

vertigo, 214 
Azoospermism, 735 

Baker's itch, 1038 

Balanitis, 702 

Baldness, 129 

Basedow's disease, 1S4 

Bilious fever, 470 

Bladder, 680 

Blennorrhea of bronchi, 368 

of lachrymal sac, 139 

nasal, 221 
Blepharitis marginalis, 132 
Blepharospasm, 182 
Blisters, forming crusts, 1044 

isolated, large, 1043 
Bloatedness, 554 
Blood. 923 

in urine, 640 
Boil, 1044 

Bothriocephalic latus, 574 
Break-bone fever, 97 1 
Bright's disease, first stage, 658 

sen Hi. I stage, 663 

third stage, 667 
Broad tape-worm, 574 
Bronchia] asthma, 380 

catarrh. 365 

respiration, 355 
Bronchieetasia, 366, 368 
Bronchitis, 365 

capillaris, 367 
Bronchocele, 308 
Bronchophony. 361, 363_ 
Broncho-pneumonia, 385 
Bronchorrheea, 368 
Broncho-typhus, 981 
Bruised head after birth, 115 
Buboes, 700 



Bubo, inguinal, 713 
Bullae, isolated, large, 1043 
Bunion, 851 
Bursitis, 849 

Calculi vesica, 686 
Calvities, 1032 
Cancer of larvnx, 333 

of lip, 242 

of liver, 607 

of intestines, 564 

of pancreas, 633 

of rectum, 564 

of spleen, 631 

of stomach, 490 

of tongue, 272 

of womb, 767 
Cankers of mouth, 292 
Capsule of liver, 596 
Caput succedaneum, 115 
Carbuncle, 1045 
Carcinoma in brain, 113, 114 

hepatis, 607 

of larynx, 333 

mamma;, 790 

testis, 725 

ventriculi, 490 

of womb, 767 
Cardialgia, 482 
Carditis, 454 
Caries, 840 

of skull-bones, 117 
Catalepsy, 891 
Cataract. 170 
Catarrhal diphtheria, 296 

inflammation of biliary passages, 611 

ophthalmia, 140 

pneumonia, 385 
Catarrh, acute, of stomach. 475 

chronic, of stomach, 479 

on chest of infants, 3(37 

in head, 220 

of larynx, 317 

of middle ear, 207 

nasal, chronic, 225 

of rectum, 510 

of uterus, 744 

of vagina, 786 
Catarrhiis intestinalis, 500 
Catheterism of ear, 198 
Cauliflower excrescences, 767 
Cavernous voice, 364 
Cellulitis of eye-orbit, 184 
Cephalalgia, 855 

rheumatica, 823 
Cerebral paralyses, 910 
Cervico-brachial neuralgia, S66 

occipital neuralgia, 800 
Chalazion, 137 
Chancre, 702 
Chart on, 1047 
Chemosis, 142 
Chicken-pox, 1029 
Chimney sweepers' cancer, 104S 



IOCS 



Chiragra, 833 

Chlorides of sodium and potassium in 

urine, 636 
Chlorosis, 930 
Chlosmata uterina, 1031 
Cholsemia, 618 
Cholelithiasis, 612 
Cholera, 519 

infantum, 529 

morbus, or nostras, or Europaea, 527 
Cholesteatoma in brain, 112 
Chordee, 694 
Chorea, 878 
Choroiditis, 161 
Chromotopsy, 170 
Chronic intestinal catarrh, 503 

rheumatism of the joints, 822 

sore throat, 283 

tumor of spleen, 630 
Chyle in urine, 639 
Cirrhosis of kidney, 667 

of liver, 600 
Clavi, 1031 
Click in throat, 359 
Clinical thermometry, 943 
Closure, partial or total, of womb, 755 
Coating of tongue, 267 
Coccvodvnia, 817 
Cold' in head, 220 
Colica, 555 

renalis, 673 
Colloid liver, 606 
Color of face, 237 

of tongue, 266 
Coma, 55 
Comedo, 241 
Comedones, 1059 
Condylomata. 712, 1032 
Congestion to brain, 37 

of liver, 594 
Congestive fever, 959 
Conjunctiva, 140 
Conjunctivitis crouposa, 150 

diphtheritica, 150 
Consistency of tongue, 269 
Constipation, 535 
Constriction of aortic opening, 450 

of left an riculo- ventricular opening, 
448 
Consumption of bowels, 563 

pulmonary, 394 
Continuous malarial fever, 959 
Contracting kidney, 667 
Convulsion, 875 
Convulsions of children, 902 
Corneitis, 152 
Corns, 1031 
Cornua, 1031 
Corvza, 220 
Coxalgia, 843 
Coxarthrocace, 843 
Covering of tongue, 267 
Cracks on tongue, 269 
Cramp, 875 



Cramp of stomach, 482 
Craniotabes, 116 

Crick in the back, 823 
Crisis and critical days, 945 
Croup, 322 
Croupous conjunctivitis, 150 

diphtheria, 296 

pneumonia, 386 
Crural neuralgia, 873 
Crusta lactea, 239, 1039 

serpiginosa, 1039 
Cucurbitina, 573 
Curvature of the spine, 850 
Cyanosis, 923, 1032 
Cvclitis, 162 
Cystitis, 680 
Cysts in brain, 112 

in the ovaries, 740 

Dacrvocvstitis, 138 
Dandruti; 125, 1038 
Deafness, nervous, 213 
Decubitus, 1033 
Delirium epilepticum, 895 

tremens, 103 
Dementia paralytica, 96 

senilis, 98 
Dengue, 971 
Dermatitis, 1033 
Deuteropathic parotitis, 276 
Diabetes, 642 

insipidus, 651 
Diaphragmitis, 466 
Dilatation of heart, 454 

of oesophagus, 312 
Diphtheria, 294 
Diphtheritic conjunctivitis, 150 
Diphtheritis, 294 
Dipsomania, 107 
Diseases of abdomen, 472 

of aorta, 464 
Diseases of endocardium, 444 

of heart-muscle, 454 

of pericardium, 43S 
Dislocation of the lens, 172 
Displacements of womb, 756 
Dissolution of red corpuscles, 924 
Distiachis, 132 
Divertieles of bladder, 681 
Diverticula, 313 
Dochmius duodenalis, 576 
Dolor faciei Fothergillii, 862 
Doppelte Glieder, 835 
Dropsy of chest, 426 

of pericardium, 443 

of peritoneum, 588 

of scalp, 114 
Drumhead, 191 
Dry catarrh, 368 

pleurisy, 417 

tubercles, 718 
Dysentery, 513 
Dysmenorrhea!, 782 
Dyspepsia, 472 



1064 



Dysphagia inflammatoria, 309 

Ear speculum, 197 
Earwax, 193 
Echinococcus cysts, 609 

in spleen, 631 
Eclampsia acuta, 900 

gravidarum and parturientium, 901 

infantum, 902 
Ecthyma, 1042 

syphiliticum, 717, 719 
Ectropium, 132, 136 
Eczema, 1038 

of auricles, 190 

capitis, 122 

impetiginosum, 1039 

marginatum, 1039 

rubrum, 1039 
Emholism in brain, 87 
Empboric echo, 364 
Emphysema pulmonum, 405 
Empyema, 419 
Encephalitis, 76 
Endocarditis, 444 
Endometritis, 744 

Enlargement of the prostate gland, 727 
Enteralgia, 555 
Enteritis eatarrhalis, 500 
Entero-colitis, 529 
Entozoes, 568 
Entropium, 132, 136 
Enuresis nocturna, 691 
Ephelides, 1031 
Epididymitis, 699 
Epilepsy, 892 
Epileptic vertigo, 895 
Epistaxis, 232 
Epithelial cancer, 1048 
Epithelioma. 1048 

on eyelids, 138 

of face, 242 
Epulis, 245 
Erysipelas of scalp, 118 

" of face. 118, 239 
Erythema, 1033 
' nodosum, 1034 

papulatum sen tuberculosum, 1033 
Erythematous syphilide, 719 
Examination of abdomen, 469 

of auditory canal, 191 

of female organs, 736 

of middle ear, 197 

of nasal cavity, 219 

ofurine, 634 
Exanthemata, 1001 
Exophthalmic goitre, 184 
Exophthalmos, 184 
Exostosis, 840 
Expiratory murmur, 354 
Expression of face, 237 
External strangulation of bowels, 540 
Extravasation of blood in spine, 794 
Eyelids, inflammation of, 131 
Eyes, expression of, 131 



Face, 235 

Falling of upper eyelid, 180 

Fat tape-worm, 574 

Fatty degeneration of heart. 456 

disease of pancreas, 633 

heart, 456 

liver, 605 

tumors on eyelids, 137 
Favus, 126 
Febris mucosa, 476 
Felon, 1048, 1049 
Female organs, 736 
Fever, 943 

and ague, 946 
Fever-blisters, 1034 
Fibroma papillare of larynx, 332 
Fig-warts, 712, 1032 
Fish-skin, 1031_ 
Fissura ani, 565 
Fissures on tongue, 269 
Fistula dentalis, 246 
. lachrymalis, 138 

recti, 512, 566 

of teeth, 246 
Fixed eyeball, 182 
Flatulency, 554 

Follicular catarrh of tonsils, 278 
Form of thorax, 341 

of tongue, 268 
Freckles, 1031 

Friction sound of pleura, 360 
Frog, 277 

Fungoid growth on gums, 245 
Furuncles, 1044 

of auditory canal, 195 

Gall-stones, 612 
Gall-stone colic, 614 
Gangrsena pulmonum, 411 

of cheeks, 306 
Gangrenous diphtheria, 207 
Gastralgia, 4S2 
Gastric fever. 476 
Gastritis, 475 

toxica sen caustica, 481 
Gastromalacia, 49S 
General observations on the ear, 1S9 
Gin-drinkers' liver, 600 
Glaucoma, 163 
Gleet, 695 

Glioma of brain, 111, 114 
Glisson's capsule, 596 
Glossanthrax, 271 
Glossitis, 270 
Glycosuria. 642 
Gonagra, 833 
Goitre, 308 
Gonarthrocace, S47 
Gonorrhoea, 693 

Gonorrhoea] contamination of the general 
system, 701 

ophthalmia, 143 

rheumatism, 701 
Gonorrhoea of rectum, 700 



10G5 



Gonorrhoea spuria or praeputialis, 702 

vesica;, 700 
Gout, 831 

of the brain, 833 

of the heart, 833 

of the stomach, 833 
Granulated liver, 600 
Granular atrophy of kidnev, 667 

ophthalmia, 145 
Grape-sugar in urine, 638 
Graphospasm us, 878 
Grating feel in thorax, 344 
Gravedo, 221 
Gravel, 673 
Grave's disease, 184 
Gray degeneration of posterior columns, 

809 
Grippe, 229, 367 
Gumboil, 245 
Gummata, 720 
Gums, 245 

Hcematemesis, 495 
Haematopneumothorax, 424 
Hasmatothorax, 429 
Hematuria, 652 
Haemometra, 755 
Haemophilia, 939 
Haemoptoe, 412 
Haemoptysis, 412 
Haemorrhage of choroidea, 163 
Haemorrhage of lungs, 412 

in retina, 167 
Haemorrhage from stomach, 495 

from the womb, 771 
Haemorrhagia intestinalis, 546 
Hsemorrhagic infarction, 412, 413 

» of spleen, 627 
Haemorrhoides, 547 
Hsemorrhophilia, 939 
Hair cutting, 129 

gray and white, 130 
Hard cataract, 170 
Hav asthma, 231 

fever, 231 
Headache, 855 
Heart, 430 

clots, 453 
Helminthes, 569 
Hemeralopia, 169 
Hemicrania, S55 - 
Hemiopia, 108 
Hemiplegia, 908 
Hepar adiposum, 605 
Hei^atitis suppurativa, 597 

vera circumscripta, 597 
Hernia, 540 
Herpes, 1034 

circinnatus, 1036 

facialis, 1034 

iris, 1036 

labialis, 1034, 292 

phlyctenoides, 1034 

prseputialis, 1035 



Herpes tonsurans, 128 

Zona, 1035 
Hiccough, 467 
Hip-disease, 843 
Hob-nail liver, 600 
Honey-comb ringworm, 126 
Housemaid's knee, 849 
Hordeolum, 136 
Horns, 1031 

Humectation of tongue, 266 
Humid tetter of scalp, 122 
Hydatids of liver, 609 

of womb, 767 
Hvdraemia, 926 
Hydroa, 292 

febrilis, 1034 
Hydrocele, 722 
Hydrocephaloid, 35 

Hvdrocephalus acutus sine tuberculosis 
58. 60 

congenitus, 68 

chronicus, 68 

senilis, 70 
Hydrosarcocele, 725 
Hydrometra, 755 
Hydronephrosis, 675 
Hydropericardium, 443 
Hydrophobia, 916 
Hydropneumothorax, 424 
Hydrops cystidis fellea;, 615 

ovarii, 740 
Hvdrorrhachis congenita, 800 
Hydrothorax, 426 
Hvperaemia of brain, 36 

of lungs, 409 

of liver, 594 

of the skin, 1032 

of spine, 794 

of spleen, 629 
Hyperesthesia, 853 

of bladder, 688 

of larynx, 334 

retinae, 169 

of soft palate, 281 
Hyperidrosis, 1058 
Hyperkinesis, 875 
Hypermetropia, 175 
Hyperplasia of pineal gland, 112 
Hypertrothy of brain, 94 

of cutaneous capillaries, 1032 

of heart, 454 

of the nerves, 852 

of skin, 1030 

of skull, 115 

of spleen, 630 
Hyperuresis, 651 
Hypopion, 153 
Hvsteralgia, 771 
Hysteria, 883 

Ichthyosis, 1031 
Icterus, 618 

gravidarum, 621 

menstrualis, 621 



1066 



Icterus neonatorum, 621 
Ileo-typhus, 975 
Ileus, 545 
Impetigo, 1038 
Impetigo, 1041 

contagiosa, 1041 

of scalp, 123 
Impotence, 734 
Incontinentia urinse, 690 
Indigestion, 472 

Induration of connective tissue of kid- 
neys, 667 
Infantile wasting palsy, 915 
Inflammation of auditory canal, 196 

of bladder, 680 

of the breast, 788 

of connective tissue of throat, 288 

of diaphragm, 466 

of dura mater, 75 

of eyelids, 131 

of Glisson's capsule, 596 

acute, of the gray anterior columns 
or anterior horns, 815 

chronic, of the grav anterior horns, 
816 

of heart-muscle, 454 

of the nerves, 852 

of nose, 234 

of pancreas, 633 

of pericardium, 438 

of pleura, 415 

of prostata, 699 

of the prostate gland, 726 

of renal capsule, 677 

of renal pelvis, 676 

of the skin, 1033 

of spinal marrow, 803 

of spleen, 627 

of stomach from poison, 481 

of testicles, 724 

of tongue, 270 

of tonsils, 278 

of uvula, 281 

of the vermiform process, 506 
Inflammatory swelling of gums, 245 
Influenza, 229, 367 
Ingrowing toe-nails, S51 
Inguinal bubo, 713 
Insomnia, 55, 57 
Inspection of thorax, 339 
Inspiratory murmur, 3-">4 
Insufficiency of aortic valves, 449 

of bicuspid valve, 447 

of mitral valve, 447 

of pulmonary valves, 451 

of tricuspid valves, 450 
Insulatia, 78 

Intercostal neuralgia, S67 
Interlobular emphysema, 406 
Intermittent fever, 946 
Internal strangulation of bowels, 540 
Interstitial inflammation of kidneys, 667 

inflammation of liver, 600 
Intertrigo, 1033, 1038 



Intestinal canal, 500 

catarrh, 500 

catarrh of infants, 529 

haemorrhages, 546 

worms, 569 
Intussusception, 544 
Irritability of bladder, 688 
Iritis, 158 
Ischias antica, 873 

postica, 869 
Itch, 1054 

Invagination of bowels, 544 
Inversion of womb, 759 

Jaundice, 618 

from mental emotions, 621 

Keratitis, 152 
Kidnevs, 634 
Kink in the back, 823 
Kyphosis, 850 

Labyrinthine vertigo, 214 
Lardaceous kidnev, 671 

liver, 606 
i Large, white kidney, 663 
Laryngismus stridulus, 336 
Laryngitis catarrhalis, 317 

chronica, 320 

phlegmonosa, 327 

stridulosa, 336 
Laryngophony, 361 
Laryngoscopy, 315 
Larynx, 314 
Lead tremor, 906 
Lentigines, 1031 
Leptomeningitis infantum, 60 

spinalis, 801 
Leucoma cornea;, 154 
Leucomyelitis posterior chronica, 
Leucorrhoea, 744 
Leukaemia, 925 
! Lichen, 1052 



planus, 1052 

ruber, 1052 

simplex, 1052 

syphiliticus, 716 
Lieni'tis, 627 
Liver, 592 

spots, 1031 
Lobular pneumonia, 3S5 
Loss of hair, 718 
Lumbago rheumatics, 823 
Lumbc-ubdominal neuralgia, 
Lupus of face, 242 

syphiliticus, 71S 
Luscitas, L s 2 
Lyssa, 91*5 

Macula cornea?, 154 
Macular svphilide, 715 
Malacosteon, 837 

Malaria, 947 
Malama, 546 



1067 



Male genitals, 693 
Malignant pustule 1047 
Malum Cotunnii, 869 

Pottii, 850 

senile, articulorum, 834 
Mammae, 788 

Manual examination of thorax, 342 
Mastitis, 788 
Mastodynia, 868 
Matted hair, 130 
Measles, 1001 
Melansemic liver, 593 
Melanoma in brain, 112 
Mellituria, 642 
Membrana tympani, 191 
Meniere's disease, 214 
Meningitis cerebro-spinalis, 70 

of the convexity, 62 

metastic, 62 

simple, 60 

simple, of the base, 61 

traumatic, 63 

tuberculosa, 58 
Menorrhagia, 176 
Menstruatio difficilis, 782 
Mercurial tremor, 906 
Metallic tinkling, 359, 364 
Metastic parotitis, 276 
Meteorism, 554 
Metritis, parenchymatous, 751 
Metrorrhagia, 771 
Microsporon audonini, 129 
Middle ear, 197 
Migraena, 855 
Miliaria alba, 1058 

rubra, 1058 
Miliary rash, 1058 
Milium, 1059 
Milk crust, 239 
Milzbrand, 1047 
Mimic spasm of the face, 877 
Miserere, 545 
Mogigraphia, 878 
Moles, 766 
Mollifies ossium, 837 
Molluscum, 1059 

simplex, 1032 
Morbilli, 1001 

asthenici, nervosi, torpidi, septic 
1004 

confluentes, 1001 

hemorrhagica, 1001 

inflamatorii or svnochales, 1003 

petechialis, 1001 

simplices or vulgares, 1003 
Morbid growths within the womb, 765 
Morbus Addisonii, 678 
Morbus anglicus, 835 
Morbus maculosus Werlhofii, 938 
Morphine-poisoning, 110 
Mother's mark, 128 
Motor v apparatus, 820 
Mouth, 244 
Mucous rattle, 358 



Mumps, 274 

Muscular rheumatism, S23 

Myalgia cervicalis, 823 

lumbalis, 823 

pectoralis et intercostalis, 823 

rheiimatica, 823 

scapularis, 823 
Mydriasis, 179 
Myelitis, 803 
Myelomalacia, 806 
Myocarditis, 454 
Myopathia, 823 
Myopathic paralyses, 910 
Myopia, 175 
Myosis, 179 
Myxoma, in brain, 113 

Nam spili, 1031 

Naevus vascular, 128 

Nasal catarrh, purulent, 221 

blennorrheea, 221 
Neck, 307 
Necrosis, 840 
Neoplasms of larynx, 332 
Neoplastic formation iu the nerves, S" 
Nephralgia, 673 
Nephritis, acute desquamative, 058 

albuminous, 658 

catarrhal, 658 

croupous, 658 

hemorrhagic, 658 

non-desquamative, 663 

parenchymatous, 658 
chronic, 663 

suppurativa, 673 
Nephrolithiasis, 673 
Nerves 852 

Nervous affections of heart, 458 
Nervous deafness, 213 
Nervousness, 853 
Nettle-rash, 1036 
Neuralgia, 854 

of diaphragm, 468 

in ear, 216 

of eve, 183 

facialis. 862 

ischiadica, 869 

of larynx, 334 

of mammas, 868 
Neurasthenia spinalis, 799 
Neuritis, 852 
Neuroma in brain, 112 
Neuromata vera, spuria, S53, 
Neuro-retinitis, 166 
Neun ses of larynx, 333 
Nicotine tremor, 906 
Night-blindness, 109 
Nodular gout, 834 
Noises in ears, 215 
Noma, 306 
Nose, 217 
Nosebleed, 232 
Numbness, 853 
Nun's murmur of heart, 437 



10(38 



Nutmeg liver, 594 
Nystagmus, 181 

Observations, general, on face, 235 
on mouth, 24-1 

on neck, 307 
on nose, 217 
Occlusion of cerebral arteries, 87 

of portal vein, 616 
Odontalgia, 248 
OZdema glottic! is, 327 

laryngis, 327 

of lungs, 409 

of uvula, 281 
Oesophagitis, 309 
CEsophagns, 309 
Old sight, 174 
Oligsemia, 927 
Omagra, 833 

Omodynia rheumatica, 823 
Onyx,' 153 
Oophoritis, 737 
Ophthalmia catarrh alis, 140 

gonorrhoica, 143, 700 

granulosa, 145 

neonatorum, 143 

phlyctenular, 147 

purulenta, 142 

scrofulosa, ]52 

tarsi, 132 
Opium-poisoning, 110 
Opium tremor, 906 
Orbital cellulitis, 184 
Orchitis 699, 724 
Organs of generation, 693 
Osteitis, 840 
Osteomalacia, 837 
Ostitis of skull, 117 
Otalgia nervosa, 216 
Otitis externa, 196 

media, 202 

chronica, 207 
Ovarian dropsy, 740 
Ovaries, 737 
Ovaritis, 737 

Oxvuris vermicularis, 569 
Ozsena, 225 

Pachymeningitis, 75 
Palpation of thorax, 342 

Palpitation, nervous, 458 
Palsy, infantile wasting, 915 

shaking, 906 
Panaritium, 1048 
Pancreas, 032 
Pancreatitis, 633 
Pannus, 146, 153 
Papilloma of larynx, 332 
Papular syphiKde, 715, 719 
Paralysis, 908 

agitans, 906 

ascend ens acuta, 816 

of bladder, 689 

after diphtheria, 305 



Paralysis of larynx, 334 

spinal, atrophic, 816 

of tongue, 269 

of uvula and soft palate, 280 
Paranephritis, 677 
Paraphasia, 90 
Paraphimosis, 694 
Paraphrenias, 420 
Paraplegia, 908 
Parenchymatous nephritis, 658 
Paresis of bladder, 689 
Paronychia, 1048 
Parotitis, 274 
Parulis, 245 

Passing blood with urine, 652 
Pemphigus, 1043 

foliaceus, 1043 

syphiliticus, 717 
Percussion of thorax, 346 
Perforation of diaphragm, 468 
Pericardial murmurs, 437 
Pericarditis, 438 
Perichondritis laryngea, 329 
Perihepatitis, 596 
Perinephritis, 677 
Perioophoritis, 738 
Peripheral paralyses, 909 
Periproctitis, 512 
Peritonitis, 584 
Perityphlitis, 506 
Pernicious intermittent, 959 
Pertussis, 376 
Petechial typhus, 972 
Phimosis, 694 

Phlyctenular ophthalmia, 147 
Phosphates in urine, 637 
Phosphenes, 170 
Photophobia, 1G9 
Photopsia, 170 
Phthisis, 394 

laryngis, 330 
Physical examination of spleen, 625 
Pianist's cramp, 878 
Pigment liver, 593 
Piles, 547 
Pin-worm, 509 
Pithiness, 853 

Pityriasis palmaris et plantaris, 1040 
Plague, 999 
Plethora, 927 
Pleurisy. 415 
Pleurit'is, 415 

sicca. 417 
Pleurodynia rheumatica, S23 
riica polonica, 130 
Pneumonia, 385 

from embolism, 3S5 

notha, 367 
Pneumothorax, 424 
Pneumo-typhus, 9S1 
Podagra, 831 
Podartbrocace, 849 
Pollutiones nocturme et diurnse, 730 
Poliomyelitis anterior acuta, 815 



1009 



Poliomvelitis anterior chronica, 816 
Pulitzer's met hod, 198 
Polyarthritis rheumatics acuta, 820 
Polydipsia, 651 
Polypanarthritis, 834 
Polypi of ear, 212 

of heart, 453 

of larynx, 333 

in nose, 234 

of rectum, 565 

of the skin, 1032 

of womb, 765 
Polyuria, 651 
Pompholyx, 1043 
Porrigo devalcans, 129 

favosa, 126 

larvalis, 1039 

lupinosa, 126 
Post-diphtheritic paralysis, 305 
Posterior staphyloma, 162 
Prairie itch, 1057 
Preacher's sore throat, 283 
Presbyopia, 174 
Pressure diverticula, 313 
Prickly heat, 1058 
Procidentia uteri, 758 
Proctalgia, 569 
Proctitis, 510 
Proglottides, 573 
Progressive locomotor ataxy, 809 

muscular atrophy, 83S 

pernicious anaemia, 928 
Prolapsus recti, 568 

uteri, 758 
Prosopalgia, S62 
Prostata, 726 
Prostatitis, 726 

gonorrhoica, 699 
Prurigo, 1053 

contagiosa, 1057 

formicans, 1053 

mitis, 1053 

pudendorura, 1053 
Pruritus, 1053, 1054 

vulvae, 787 
Psammona in brain, 112 
Psoriasis, 1051 

annulata, 1051 

diffusa, 1051 

guttata, 1051 

gyrata, 1051 

inveterata, 1052 

palmaris, 1040, 1052 

plantaris, 1040, 1052 
Pterygium, 151 
Ptosis, ISO 

Puerperal convulsions, 901 
Pulmonary apoplexy, 412, 413 

consumption, 394 
Purpura hemorrhagica, 938 

simplex, 939 

variolosa, 1025 
Purulent nasal catarrh, 221 

inflammation of portal vein, 617 



i Purulent ophthalmia, 142 
Pustula maligna, 1047 
Pustular eruption, 1041 

syphilide, 717 
Pustules isolated, large, 1042 
Putrid sine mouth, 292 
Pyelitis, 676 
Pylephlebitis adha?siva, 616 

suppurativa, 617 
Pylethrombosis, 616 
Pyopneumothorax, 424 
Pyothorax, 419 

Quantity of urine, 642 
Quinsy, 278 
Quivering of lids, 182 

Rabies, 916 

Rachitis, 835 

Rachitismus, 835 

Ranula, 277 

Reaction of urine, 634 

Red corpuscles, dissolution of, 924 

Refraction, 172 

Relapsing fever, 996 

Remittent malarial fever, 959 

Renal abscess, 673 

calculi, 673 

cirrhosis, 667 

gravel, 673 
Respiratory motion of chest, 339 
Retinitis albuminuric^, 166 

apoplectiea, 167 

diabetica, 167 

leucsemica, 167 

pigmentosa, 167 

syphilitica, 167 
Retroflexion of womb, 757 
Retro-pharyngeal abscess, 2>7 
Retroversion of womb, 757 
Rheumatic gout, 834 
Rheumatism of the joints, 820 
Rheumatismus, 820 

articulorum acutus, 820 

articulorum chronicus, 822 

muscularis, 823 

nodosus, 834 
Rhonehi in chest, 355 
Rhonehns crepitans, 357 

vibration, 344 
Rhvpia, 1044 
Rickets, 835 
Ringworm, 1036, 1051 

of scalp, 128 
Rodent ulcer, 1048 
Rcetheln, 1020 
Roseola syphilitica, 715 
Rose cold, 231 

Round perforating ulcer of stomach. 486 
Round-worm, 570 
Rubbing feel in thorax, 344 
Rubeola, 1020 
Rubeola; nigra;, 1001 
Run-around, 1048, 1049 



1070 



Rupia, 1044 

syphilitica, 717 
Rupture of diaphragm, 468 
of spleen, 631 

Saeo-spleen, 630 
Saliva, 273 
Salivary glands, 273 
Sand-tumor in brain, 112 
Sarcocele, 725 
Sarcoma in brain, 113 
Sarcoptes hominis, 1054 
Salt-rheum, 1038, 1039 
Scabies, 1054 
Scald of scalp, 122 
Scarlatina, 1007 

hemorrhagica, 1007 

laevigata, 1007 

maligna, typhosa, 1010 

miliaris, 1007 

papulosa, 1007 

variegata, 1007 
Sciatica, 869 
Scleritis, 157 
Sclerosis of kidney, G67 

nC middle ear, 207 

multiple, 806 

of the posterior columns, 809 
Sclerotico-choroiditis posterior, 162 
Sclerotitis, 157 
Scirrhus mammae, 790 

ventriculi, 490 

of womb, 767 
Scorbutus, 935 
Scotomata, 169 
Serofulosis, 940 
Scrofulous ophthalmia, 152 
Sou ivy, 935 
Sea-sickness, 51 
Scat-worm, 569 
Sebaceous tumors, 137 
Seborrhoea, 1059 

capillittii, 126 
Sediments of urine, 641 
Sensitiveness, morbid, 853 
Septic diphtheria, 297 
Serous pneumonia, 3S5, 410 
Shaking palsy, 906 
Shingles, 1035 
Short-sightedness, 175 
Sick-headache, 855 
Sight, 172 
Singultus, 467 
Size of tongue, 268 
Skin, 1030 
Sleep, 32 
Sleeplessness, 55 
Small-pox, 1021 
Snuffles of infants, 225 
Softening of the bones, 837 
Softening of brain, S7 
Softening, red and yellow, of brain, 76 
Softening of spinal marrow, S06 
Softening of stomach, 498 



Soft cataract, 170 

Soft occiput, 116 

Soft palate, 280 

Sore mouth of infants, 289 

nipples, 1040 

throat, 281 
Spasm, 875 

of bladder, 688 

of glottis, 336 
Spasmodic spinal paralysis, 813 
Spasmus facialis, 877 
Specific gravity of urine, 612 
Spermatocele, 726 
Spermatorrhoea, 730 
Spine, 793 
Spina bifida, 800 
Spinal irritation, 796 

nervous weakness, 799 

paralysis, 909 
Spleen, 625 

Spondylarthroses, 850 
Spotted fever, 70 
Squamous svphilide, 716, 719 
Squint, 180" 
Stagnation aktasia, 312 
Staphyloma cornea, 154 

posterior, 162 

sclerse, 158 
Stenocardia, 461 
Stenosis of aortic opening, 450 

of left auriculo-ventricular opening, 
448 

oesophagi, 311 

of pulmonary opening, 451 

of right auriculo-ventricular open- 
ing, 451 
Sterilitv in the male, 734 
Stiff neck, 623 
Stinknose, 226 
Stomacace, 292 
Stomatitis ulcerosa, 291 
Stones in bladder, 6S6 
Strabismus, 180 
Stricture of CESOphagUS, 311 

of urethra, 700 
Strongulus duodenalis, 576 
Struma, 308 

Strumous ophthalmia, 152 
Stupor, 55 
St. Vitus' dance, 878 
Stye, 136 

Subcxepitant rattle, 358 
Sudamina, 1058 
Sulphates in urine, 638 
Summer complaint, 529 
Sunstroke, 78 

Suppuration of middle ear, 207 
Swamp-miasma, 947 
Swelled face, 265 
Sycosis, 712 

Symptomatic parotitis, 276 
Synchronous respiration and pulsation, 

340 
Syphilides, 715 



1071 



Syphilis congenita s. hereditaria, 721 

constitutional, 705 

laryngis, 332 
Syphilitic affections of bones, 719 

of cartilages, 719 

of inner organs, 721 

of mucous membranes, 719 

of periosteum, 719 
Syphilitic contractions of muscles and 
tendons, 720 

inflammation of liver, 602 

skin diseases, 715 

tumors in brain, 113 

Tabes dorsalis, 809 
Tsenia canellata, 574 

media canellata, 573, 574 

saginata, 573, 574 

solium, 572 
Tape-worms, 572 
Teeth, 246 

Teleangiectasia, 128, 1032 
Temperature of face, 239 

of tongue, 267 
Testes, 722 
Tetanus, 887 

neonatorum, 889 
Thermic fever, 78 
Thermometry, 943 
Thoracic breathing, 341 
Thorax, 339 
Thread-worm, 569 
Thrombosis in brain, 87 

of cerebral sinuses, 93 

of portal vein, 616 
Thrombus neonatorum, 115 
Thrush, 289 
Tic douleureux, 862 
Tinea amiantacea, 1038 

capitis, 1038 

faciei, 1039 

favosa, 126 

furfuracea, 1038 

maligna, 126 

of scalp, 128 

tarsi, 132 
Tinnitus aurium, 215 
Tongue, 266 
Tonsillitis, 278 
Tonsils, 277 
Toothache, 248 
Top-murmur of heart, 437 
Torsion of bowels, 543 
Torticollis rheumaticus, 823 
Trachea, 314 
Tracheophony, 361 
Traction diverticula, 313 
Traumatic cataract, 171 
Trembling, 905 

of eyeballs, 181 
Tremor, 905 
Trichiasis, 132, 136 
Trichina spiralis, 577 
Trichinosis, 579 



Tricocephalus dispar, 576 
Trigeminal neuralgia, 862 
Trismus, S87 

neonatorum, 889 
Tubercles in brain, 112, 114 

sypbil., 719 
Tubercula mucosa, 712 
Tubercular ulceration of larvnx, 330 

syphilide, 718 
Tuberculosis, acute miliary, 403 

intestinalis, 563 

of the joints, 842 
Tumor albus genu, 847 
Tumors of brain, 111 

of eyelid, 137 

of the prostate gland, 727 
Tuning-fork, examination of ear, 200 
Tussis convulsiva, 376 
Twisting of bowels. 543 
Twitching of lids, 1S2 
Tylosis, 132 

Tympanites abdominalis, 592 
Typhlitis, 506 
Typhoid fever, 975 

pneumonia, 389 
Typhus, 972 

abdominalis, 975 

ambulatorius, 981 

exanthematicus, 972 

recurrens, 996 

tumultarius, 931 

Ulcerated sore throat, 286 
Ulceration of cornea, 153 
Ulcers in fauces, 286 

in mouth, 291 
Ulcus rodens of face, 242 
Ulcus ventriculi perforans, or rorundi 

or chronicum, 486 
Unarmed tape-worm, 574 
Urates in urine, 63S 
Uraemia, 657 
Urea, 636 

L rinary casts or cylinders, 640 
Urinae profluxio, 651 
Urticaria, 1036 

febrilis, 1037 
Uterus, 744 
Uvula, 280 

Vagina, 786 
Vaginitis, 786 
Valsalva's method, 198 
Varicella, 1029 
Varicocele, 725 
Variola, 1021 
Varioloid, 1021, 1025 
Variolois, 1021 
Venereal diseases, 693 
Venous murmurs of heart, 437 
Verrucae vulgares, 1032 
Vertigo, 41 

labyrinthine, 214 
Vesicular emphysema, 405 



1072 



Vesicular eruption, 1038 
Vesiculse seminales, 730 
Vibration of voice, 343 
Vitiligo, 1032 
Vocal fremitus, 343 
Vomiting, 474 

Warts, 1032 

on eyelids, 137 
Watch, examination of ear, 200 
Waxv kidney, 671 

iiver, 606 
Wen on scalp, 128 
Werlhofs disease, 938 
Winking of eyelids, 182 
White swelling, 842 



White swelling of the knee, 847 
Whitlow, 1048 
Whooping-cough, 376 
Word-blindness, 90 

deafness, 90 
Worms, intestinal, 569 
Writer's cramp. 878 
Wry neck, 823 

Yearly cold, 231 
Yellow fever, 961 

Zona, 1035 
Zoster, 1035 
Zweiwuchs, 835 



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